Bachelor of Arts, University of California Santa Cruz (2011)
Master of Arts, Maryland Institute, College Of Art (2016)
Doctor of Psychology, Palo Alto University (2022)
PsyD, PGSP-Stanford PsyD Consortium, Clinical Psychology (2022)
MS, PGSP-Stanford PsyD Consortium, Clinical Psychology (2019)
MPS, Maryland Institute College of Art, Information Visualization (2016)
BA, University of California, Santa Cruz, Psychology (2011)
Jerome Yesavage, Postdoctoral Faculty Sponsor
Investigating Inter- and Intra-individual Differences in Tai Chi Practice Time, Pain, and Mood Among Participants with Chronic Nonspecific Neck Pain: Secondary Analysis of a Randomized Controlled Trial
Journal of Integrative and Complementary Medicine
2023; Online ahead of print
View details for DOI 10.1089/jicm.2022.0789
Examining the temporal dynamics of anxiety and depressive symptoms during a therapist-supported, smartphone-based intervention for depression: Longitudinal observational study
JOURNAL OF CLINICAL PSYCHOLOGY
This study examined the temporal dynamics of anxiety and depressive symptoms during a 12-week therapist-supported, smartphone-delivered digital health intervention for symptoms of depression and anxiety.A total of 290 participants were included in the present analyses (age Mean = 39.64, SD = 10.25 years; 79% female; 54% self-reported psychotropic medication use). Linear mixed models were used to examine the concurrent anxiety-depression association and (2) the lead-lag anxiety-depression relationship, with greater anxiety predicted to precede an increase in depression.In support of Hypothesis 1, greater anxiety during the current biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment. In support of Hypothesis 2, greater anxiety during the prior biweekly assessment was associated with greater depressive symptoms during the current biweekly assessment but not vice-versa.These findings demonstrate that anxiety and depressive symptoms may overlap and fluctuate in concert, with anxiety symptoms predicting subsequent depressive symptoms but not vice-versa. With sensitivity to study limitations, implications for future intervention designs are discussed.
View details for DOI 10.1002/jclp.23401
View details for Web of Science ID 000809190500001
View details for PubMedID 35687851
A prospective study of social competence in survivors of pediatric brain and solid tumors.
Pediatric blood & cancer
BACKGROUND/OBJECTIVES: Survivors of pediatric brain tumors are at increased risk for difficulties with social competence, including poor social information processing (SIP) and peer relationships. Improved survival rates heighten the need to better understand these challenges and if they are specific to survivors of pediatric brain tumors versus survivors of other childhood cancers.METHODS: Fifty-one survivors of pediatric brain tumors and 34 survivors of pediatric solid tumors completed evaluations of SIP and peer relationship quality within six months of completing treatment and one year later. Caregivers completed a measure of social skills. Linear mixed models evaluated differences between survivors of pediatric brain and solid tumors on SIP and social skills and how indices of SIP were associated with peer relationships over time.RESULTS: The two groups did not differ on indices of SIP or social skills over time. A three-way interaction between measures of SIP, group, and time predicted peer relationships. Survivors of pediatric solid tumors showed a positive association between baseline social skills and theory of mind and peer relationships over time, whereas survivors of pediatric brain tumors showed an inverse association between baseline social skills and theory of mind and peer relationships over time.CONCLUSION: Findings revealed unanticipated associations between baseline SIP and social skills and peer relationships over time among survivors of pediatric brain tumors. Additional research is needed to elucidate the factors most influential on peer relationships in this group to inform interventions.
View details for DOI 10.1002/pbc.29670
View details for PubMedID 35312152
A pilot trial of quetiapine, lithium, or placebo added to divalproex sodium for hypomanic or manic episodes in ambulatory adults with bipolar I disorder.
International journal of bipolar disorders
2022; 10 (1): 7
BACKGROUND: Many patients with bipolar I disorder do not respond to monotherapy treatment with mood-stabilizing medications, and combination regimens are commonly used in both inpatient and outpatient settings for the acute and maintenance treatment of bipolar disorder. We studied whether combination therapy is more effective than monotherapy for the acute treatment of subjects with bipolar I disorder currently experiencing manic symptoms. The primary hypothesis was that combination treatments would be associated with greater reductions in symptoms of mania and hypomania than monotherapy alone. The secondary hypothesis was that combination therapies would be associated with lower depression levels than monotherapy alone. Last, a post-hoc exploratory aim was used to examine whether the effect of side effect severity on risk-of-dropout would be greater in combination therapies than in monotherapy alone.RESULTS: In this 12-week, double-blind, placebo-controlled ambulatory pilot trial, participants (n=75) with bipolar I disorder were randomly assigned to: (1) monotherapy divalproex plus placebo (DVP+PBO), (2) combination therapy of divalproex plus blinded lithium (DVP+Li) or (3) divalproex plus blinded quetiapine (DVP+QTP). Combination therapies (vs. monotherapy) were not associated with improved symptoms of mania, hypomania or depression. The effect of side effect severity on study retention did not differ between combination therapies and monotherapy. However, the risk-of-dropout was significantly greater in the DVP+Li arm versus the DVP+PBO arm.CONCLUSIONS: No longitudinal differences in mania, hypomania or depression were found between combination therapies and monotherapy. The effect of side effect severity on study retention did not differ between groups. Due to the small sample size and differential rates of attrition between treatment arms, results of this pilot trial must be interpreted with caution. Trial registration ClinicalTrials.gov identifier: NCT00183443.
View details for DOI 10.1186/s40345-022-00252-w
View details for PubMedID 35235061
Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial.
Importance: Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD.Objective: To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment.Design, Setting, and Participants: In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020.Interventions: CBGT and MBSR.Main Outcomes and Measures: Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment.Results: Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial eta2 range, 0.38 to 0.53) with no significant between-group differences when reacting (beta, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92=-0.37; P=.71), reappraising (beta, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92=-1.67; P=.10), or accepting (beta, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92=-0.59; P=.56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT=0.031; MBSR=0.037) and accepting (CBGT=0.012; MBSR=0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment.Conclusions and Relevance: The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies.Trial Registration: ClinicalTrials.gov Identifier: NCT02036658.
View details for DOI 10.1001/jamapsychiatry.2021.1862
View details for PubMedID 34287622
Identification With the Aggressor and Inward and Outward Aggression in Abuse Survivors.
Journal of interpersonal violence
Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors' aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator's experience, identifying with the perpetrator's aggression, and replacing one's agency with that of the perpetrator were significantly associated with survivors' inward and outward aggression. Moreover, profile type-that is, having high versus low levels of identification with the aggressor-was implicated in participants' SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others.
View details for DOI 10.1177/0886260520938516
View details for PubMedID 32659159
Evening salivary cortisol as a single stress marker in women with metastatic breast cancer.
2020; 115: 104648
Flattened diurnal salivary cortisol patterns predict shorter subsequent survival with breast, lung, and renal cell carcinomas. The underlying cause of this flattened slope is undetermined, though it has been hypothesized to be secondary to a deficit in the amplitude of the circadian clock. To gain greater insight into the portions of the diurnal salivary curve that are associated with cancer survival, we examined (1) which points in the diurnal curve are predictive of the slope of the curve and (2) whether elevated evening cortisol levels alone are associated with reduced HPA-axis feedback inhibition (i.e., decreased sensitivity to the dexamethasone suppression test).We examined study hypotheses on adult women with advanced breast cancer (age = 54.3 ± 9.58 years; n = 99) using non-parametric Wilcoxon's rank-sum tests, Spearman correlation coefficients and an accuracy formula based on a confusion matrix. Cortisol was sampled five times per day for three consecutive days, with dexamethasone administered late on the second day.Salivary cortisol concentrations did not vary between those with flat and steep slopes during the morning (p's > .05), but did vary in the evening (p's < 0.05). Furthermore, the concentration of the 2100h alone was 86% accurate in discriminating between individuals classified as having "flat" or "steep" slopes. Dexamethasone suppression was only associated with diurnal salivary cortisol slope (p = .0042).Evening cortisol levels are a sensitive indicator flattened diurnal cortisol slope, suggesting evening cortisol may also be a useful predictor of breast cancer survival. Future research should focus on determining the causes of abnormally increased evening cortisol.
View details for DOI 10.1016/j.psyneuen.2020.104648
View details for PubMedID 32171899
Effect of yoga on chronic non-specific neck pain: An unconditional growth model
COMPLEMENTARY THERAPIES IN MEDICINE
2018; 40: 237-242
Chronic neck pain is a common problem that affects approximately half of the population. Conventional treatments such as medication and exercise have shown limited analgesic effects. This analysis is based on an original study that was conducted to investigate the physical and behavioral effects of a 9-week Iyengar yoga course on chronic non-specific neck pain. This secondary analysis uses linear mixed models to investigate the individual trajectories of pain intensity in participants before, during and after the Iyengar yoga course.Participants with chronic non-specific neck pain were selected for the study. The participants suffered from neck pain for at least 5 days per week for at least the preceding 3 months, with a mean neck pain intensity (NPI) of 40 mm or more on a Visual Analog Scale of 100 mm. The participants were randomized to either a yoga group (23) or to a self-directed exercise group (24). The mean age of the participants in the yoga group was 46, and ranged from 19 to 59. The participants in the yoga group participated in an Iyengar yoga program designed to treat chronic non-specific neck pain. Our current analysis only includes participants who were initially randomized into the yoga group. The average weekly neck pain intensity at baseline, during and post intervention, comprising 11 total time points, was used to construct the growth models. We performed a step-up linear mixed model analysis to investigate change in NPI during the yoga intervention. We fit nested models using restricted maximum-likelihood estimation (REML), tested fixed effects with Wald test p-values and random effects with the likelihood ratio test. We constructed 10 REML models.The model that fit the data best was an unconditional random quadratic growth model, with a first-order auto-regressive structure specified for the residual R matrix. Participants in the yoga group showed significant variation in NPI. They demonstrated variation in their intercepts, in their linear rates of change, and most tellingly, in their quadratic rates of change.While all participants benefitted from the yoga intervention, the degree to which they benefitted varied. Additionally, they did not experience a consistent rate of reduction in NPI - their NPI fluctuated, either increasing and then decreasing, or vice-versa. We comment on the clinical and research implications of our findings.
View details for DOI 10.1016/j.ctim.2017.11.018
View details for Web of Science ID 000446287800041
View details for PubMedID 30219458