Sarah Hagerty, Ph.D., is a postdoctoral fellow at Stanford University and the Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC) at the VA Palo Alto Health Care System. She graduated with a BA in Psychology from Carleton College. Recently, she completed dual PhDs in Clinical Psychology and Neuroscience at University of Colorado Boulder and pre-doctoral clinical internship at the VA Palo Alto Health Care System. Broadly, Sarah is interested in identifying clinically meaningful patient subtypes based on multimodal data, which could inform personalized interventions. Ultimately, Sarah imagines a new way of conceptualizing psychiatric diagnoses, such that an understanding of biology and behavior yield precision diagnostic insights on a more nuanced, individualized basis. Sarah sees her clinical work as a rich source for scientific hypotheses and personal inspiration, and clinical interactions serve as an important reminder of her dedication to reduce human suffering and increase fulfillment through her program of research A native of Colorado, Sarah is happiest when she's on a hiking trail, playing soccer, or spending time with family.
Bachelor of Arts, Carleton College (2013)
Ph.D., University of Colorado Boulder, Neuroscience (2020)
Ph.D., University of Colorado Boulder, Clinical Psychology (2020)
Leanne Williams, Postdoctoral Faculty Sponsor
An empirically derived method for measuring human gut microbiome alpha diversity: Demonstrated utility in predicting health-related outcomes among a human clinical sample
2020; 15 (3): e0229204
The human gut microbiome has emerged as a potential key factor involved in the manifestation of physical and mental health. Despite an explosion of cross-disciplinary interest in researching the gut microbiome, there remains to be a gold-standard method for operationalizing gut microbiome alpha diversity. Given researchers' interest in examining the relationships among gut microbiome alpha diversity and health-related outcomes of interest, a way of operationalizing the microbiome that yields a numeric value, which could be used in common statistical approaches, is needed. Thus, the current study aims to provide methodological guidance for how to operationalize microbiome alpha diversity. Findings suggest that alpha diversity of the human gut microbiome is comprised of two sub-constructs (richness and evenness), and we propose a step-by-step method of creating alpha diversity composite measures based on this key insight. Finally, we demonstrate that our empirically derived richness and evenness composite measures are significantly associated with health-related variables of interest (alcohol use, symptoms of depression) among a human clinical sample.
View details for DOI 10.1371/journal.pone.0229204
View details for Web of Science ID 000535245300015
View details for PubMedID 32119675
View details for PubMedCentralID PMC7051054
DRD2 methylation is associated with executive control network connectivity and severity of alcohol problems among a sample of polysubstance users
2020; 25 (1): e12684
Chronic exposure to alcohol and other drugs of abuse has been associated with deleterious consequences, including functional connectivity deficits within neural networks associated with executive control. Altered functional connectivity within the executive control network (ECN) might underlie the progressive inability to control consumption of alcohol and other drugs as substance use disorders progress. Genetic and epigenetic factors have been associated with substance use disorders (SUDs). For example, dopamine receptor 2 (DRD2) functioning has been associated with alcohol use disorder (AUD) and related phenotypes, including correlates of executive functioning. The present study aims to explore the relationship between a continuous measure of alcohol-related problems, epigenetic markers (methylation) within the DRD2 gene, and functional connectivity within the ECN among a sample of polysubstance users. A community sample of 658 subjects, whose consumption of alcohol, nicotine, and cannabis span across a spectrum of quantity and frequency of use, were obtained across previous studies in polysubstance using populations. Resting state functional magnetic resonance imaging was analyzed to identify intrinsic connectivity networks using a priori regions of interest. Methylation measurement of functionally relevant sites within the DRD2 gene was achieved via pyrosequencing. Regression-based models, including mediation and moderation models, tested the association between DRD2 methylation, functional connectivity within intrinsic neural networks (including the ECN), and severity of alcohol problems. Results suggest that average DRD2 methylation was negatively associated with right ECN (RECN) and left ECN (LECN) connectivity, but not associated with other networks tested, and DRD2 methylation was significantly associated with alcohol problems severity. Mediation models were not supported, although moderation models suggested that connectivity between edges within the RECN moderated the relationship between DRD2 methylation and AUD severity. Results support a theoretical model in which epigenetic factors are associated with neurobiological correlates of alcohol consumption among a sample of polysubstance users.
View details for DOI 10.1111/adb.12684
View details for Web of Science ID 000571503200005
View details for PubMedID 30370960
View details for PubMedCentralID PMC7326368
Best Practices for Approaching Cognitive Processing Therapy and Prolonged Exposure During the COVID-19 Pandemic.
Journal of traumatic stress
The COVID-19 pandemic presents major challenges for mental health care providers. In particular, providers who treat posttraumatic stress disorder (PTSD) are now tasked with determining whether to initiate trauma-focused therapy during the pandemic and, if so, whether and how to adapt treatment. The purpose of this communication is to identify and organize key considerations for whether and how to deliver commonly used evidence-supported therapy protocols for trauma treatment-specifically, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy-during the ongoing COVID-19 pandemic for adults who currently meet the criteria for PTSD. Based on relevant public health and clinical literature, we present a structured guide that can be used by treatment teams and individual providers to evaluate whether initiating CPT or PE is indicated given a particular patient-provider pair and system context amidst pandemic conditions. In addition, we suggest appropriate action steps, including problem-solving strategies, evidence-informed modifications to CPT and PE, and alternative intervention approaches.
View details for DOI 10.1002/jts.22583
View details for PubMedID 32865850
THE IMPACT OF COVID-19 ON MENTAL HEALTH: THE INTERACTIVE ROLES OF BRAIN BIOTYPES AND HUMAN CONNECTION.
Brain, behavior, & immunity health
COVID-19 along with the mitigation strategies being used to address the virus pose significant threats to our individual and collective mental health. As the crisis evolves and persists, it will be increasingly important for the research community to conduct investigations that address the mental health consequences of COVID-19. The causes of mental health effects in the context of COVID-19 are multifactorial and likely include biological, behavioral, and environmental determinants. We argue that the COVID-19 crisis significantly threatens our basic human need for human connection, which might serve as a crucial environmental factor that could underlie the overall insult to our mental health. Furthermore, "brain styles," which we have previously conceptualized as "biotypes" that are informed by a neural taxonomy, might interact with the universal threat to our need for human connection to explain the mental health consequences of COVID-19 from a precision psychiatry perspective. The goal of this commentary is to inspire research on the mental health consequences of COVID-19 from an individualized, brain-based perspective that honors the profound threat that the virus poses to our basic human motivations.
View details for DOI 10.1016/j.bbih.2020.100078
View details for PubMedID 32382727
View details for PubMedCentralID PMC7204757
Stress and number of servings of fruit and vegetables consumed: Buffering effects of monetary incentives
JOURNAL OF HEALTH PSYCHOLOGY
Diet is a key factor of human health, and additional research is needed in order to understand the psychological causes, consequences, and moderators of dietary behavior. Participants in two studies in the United States completed a 21-day intervention that involved either self-monitoring their fruit and vegetable consumption or self-monitoring combined with earning monetary incentives for behavior. Each day, participants reported their stress, affect, and consumption of fruits and vegetables. Hierarchical linear mixed effects model results suggest that on average, daily reports of higher stress were associated with fewer fruits and vegetables consumed on that day. This effect was moderated by incentive condition, such that the relationship between stress and fruit and vegetable consumption was reduced among incented participants. There was also a marginal negative effect of time on consumption of fruits and vegetables, but this was also significantly moderated by condition, such that those participants who did not receive incentives decreased their daily servings, while incented participants did not decrease over the course of the intervention. These studies suggest that incentives may be a novel method for buffering against the negative effect of daily stress on eating a healthy diet.
View details for DOI 10.1177/1359105319884620
View details for Web of Science ID 000494217200001
View details for PubMedID 31665933
An Overview and Proposed Research Framework for Studying Co-Occurring Mental- and Physical-Health Dysfunction
PERSPECTIVES ON PSYCHOLOGICAL SCIENCE
2019; 14 (4): 633–45
Mental- and physical-health conditions co-occur at a rate much higher than chance. Of patients who have a mental-health condition, more than half also have a physical disease, and these cases are associated with increased human suffering and societal cost. Comorbidity research to date has focused on co-occurring mental- and physical-health disorders separately, and relatively little research has examined the co-occurrence of mental- and physical-health dysfunction. In addition, even less is known about why mental- and physical-health dysfunction co-occurs or how to treat these cases. Thus, the aims of this article are to highlight the need for research at the intersection of physical- and mental-health dysfunction and to provide guidance on how to research cases of comorbidity. Toward these ends, we begin by presenting a selective overview of the possible role of biological processes in the co-occurrence of physical- and mental-health dysfunction using specific illustrative examples. Specifically, we outline how biological processes within the immune system and gastrointestinal system could underlie depression, irritable bowel syndrome, and their co-occurrence. We then advance and discuss a proposed research framework, including methodological and analytic guidance, that researchers could use when studying the phenomenon of co-occurring physical- and mental-health dysfunction.
View details for DOI 10.1177/1745691619827010
View details for Web of Science ID 000474242600009
View details for PubMedID 31173535
View details for PubMedCentralID PMC6778441
Cannabinoids, Pain, and Opioid Use Reduction: The Importance of Distilling and Disseminating Existing Data.
Cannabis and cannabinoid research
2019; 4 (3): 158–64
The high prevalence of chronic pain conditions combined with an over-reliance on opioid prescriptions has resulted in an opioid epidemic and a desperate need for solutions. There is some debate about whether cannabis might play a role in addressing chronic pain conditions as well as the opioid epidemic. Recent surveys suggest that a large number of people are using cannabis as a treatment for pain and to reduce use of opioids, and cannabis-derived products demonstrate at least modest efficacy in the treatment of pain in randomized controlled trials. In addition, surveillance studies from countries that have approved the use of Sativex, which is a cannabis-based product, have demonstrated that a combination of Delta9-tetrahydrocannabinol and cannabidiol has low potential for harm, is well tolerated, and is helpful to patients. Given the number of people in the United States who are already using cannabis to manage pain and opioid use in state-regulated markets, it is imperative to conduct additional research in these areas, and to disseminate information on how to minimize harm and maximize any benefits of using cannabinoids to mitigate pain and reduce opioid use. The purpose of this article is to call attention to the fact that cannabis is being used in the management of chronic pain. Thus, this article also provides a set of guidelines on how to approach using cannabis to treat pain.
View details for DOI 10.1089/can.2018.0052
View details for PubMedID 31579833
An Examination of Behavioral and Neuronal Effects of Comorbid Traumatic Brain Injury and Alcohol Use
BIOLOGICAL PSYCHIATRY-COGNITIVE NEUROSCIENCE AND NEUROIMAGING
2018; 3 (3): 294–302
Chronic alcohol use disorders (AUDs) and traumatic brain injury (TBI) are highly comorbid and share commonly affected neuronal substrates (i.e., prefrontal cortex, limbic system, and cerebellum). However, no studies have examined how combined physical trauma and heavy drinking affect neurocircuitry relative to heavy drinking alone.The current study investigated whether comorbid AUDs and mild or moderate TBI (AUDs+TBI) would negatively affect maladaptive drinking behaviors (n = 90 AUDs+TBI; n = 62 AUDs) as well as brain structure (i.e., increased atrophy; n = 62 AUDs+TBI; n = 44 AUDs) and function (i.e., activation during gustatory cue reactivity; n = 55 AUDs+TBI; n = 37 AUDs) relative to AUDs alone.Participants reported a much higher incidence of trauma (59.2%) compared with the general population. There were no differences in demographic and clinical measures between groups, suggesting that they were well matched. Although maladaptive drinking behaviors tended to be worse for the AUDs+TBI group, effect sizes were small and not statistically significant. Increased alcohol-cue reactivity was observed in bilateral anterior insula and orbitofrontal cortex, anterior cingulate cortex, medial prefrontal cortex, posterior cingulate cortex, dorsal striatum, thalamus, brainstem, and cerebellum across both groups relative to a carefully matched appetitive control. However, there were no significant differences in structural integrity or functional activation between AUDs+TBI and AUDs participants, even when controlling for AUD severity.Current results indicate that a combined history of mild or moderate TBI was not sufficient to alter drinking behaviors and/or underlying neurocircuitry at detectable levels relative to heavy drinking alone. Future studies should examine the potential long-term effects of combined alcohol and trauma on brain functioning.
View details for DOI 10.1016/j.bpsc.2017.09.012
View details for Web of Science ID 000494340900015
View details for PubMedID 29486871
View details for PubMedCentralID PMC5833016
- Biological Systems Are a Common Link Between Alcohol Use Disorder and Co-Occurring Psychiatric and Medical Conditions ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH 2018; 42 (2): 248–51
A Novel Observational Method for Assessing Acute Responses to Cannabis: Preliminary Validation Using Legal Market Strains.
Cannabis and cannabinoid research
2018; 3 (1): 35–44
Background: The development of novel cannabis research methods that are compatible with current federal regulations is imperative to conduct studies of the effects of legal market cannabis. There is very little research on higher strength, higher Delta9-tetrahydrocannabinol (THC), which has become increasingly available since legalization. Research on strains containing cannabidiol (CBD), a second primary, but nonpsychotomimetic, cannabinoid, is very limited. Materials and Methods: Using a novel observational methodology, regular cannabis users were asked to use one of two legal market cannabis strains that they purchased from a local dispensary (one strain containing 8% THC and 16% CBD (THC+CBD) and one containing a 17% THC concentration, but no CBD (THC). After using their suggested cannabis strain as they typically would for a 3-day period, participants returned to the laboratory immediately after their final use. Measures included a blood draw to measure cannabinoid blood levels and circulating cytokines, self-reported subjective drug effects, and verbal recall memory. Results: Analysis of CBD/THC concentration levels in the blood following the 3-day strain manipulation suggests that all, but one participant (n=23/24) followed instructions and used their assigned strain. Individuals in the THC group (n=11) smoked no more than their usual amount, and participants who used the THC+CBD (n=12) strain smoked more than their reported usual amount, but did not have significantly different THC+metabolite blood levels from the THC group. The THC+CBD strain was also associated with less desire to smoke, lower levels of subjective drug effects, and lower levels of circulating cytokines (TNF-alpha, IL-6, and IL-1beta) immediately after use. Conclusions: Initial results support the feasibility of this novel observational methodology involving brief manipulation of strain use. Preliminary findings indicate that participants may self-titrate cannabis use based on cannabinoid concentration and the THC+CBD strain was associated with lower levels of cannabis craving, subjective intoxication, and circulating cytokines.
View details for DOI 10.1089/can.2017.0038
View details for PubMedID 29607409
Written Lab Agreements Improve Mentoring
2018; 563 (325)
View details for DOI 10.1038/d41586-018-07383-0
TLR4 Methylation Moderates the Relationship Alcohol Use Severity and Gray Matter Loss
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2017; 78 (5): 696–705
Alcohol use disorders (AUDs) are associated with decreased gray matter, and neuroinflammation is one mechanism through which alcohol may confer such damage, given that heavy alcohol use may promote neural damage via activation of toll-like receptor 4 (TLR4)-mediated inflammatory signaling cascades. We previously demonstrated that TLR4 is differentially methylated in AUD compared with control subjects, and the present study aims to extend this work by examining whether TLR4 methylation moderates the relationship between alcohol use and gray matter.We examined TLR4 methylation and gray matter thickness in a large sample (N = 707; 441 males) of adults (ages 18-56) reporting a range of AUD severity (mean Alcohol Use Disorders Identification Test score = 13.18; SD = 8.02). We used a series of ordinary least squares multiple regression equations to regress gray matter in four bilateral brain regions (precuneus, lateral orbitofrontal, inferior parietal, and superior temporal) on alcohol use, TLR4 methylation, and their interaction, controlling for demographic, psychological, and other substance use variables.After we corrected for multiple tests, a significant Alcohol × TLR4 Methylation interaction emerged in the equations modeling left precuneus and right inferior parietal gray matter. Follow-up analyses examining the nature of these interactions demonstrated a significant negative association between alcohol and precuneus and inferior parietal gray matter in individuals with low TLR4 methylation, but no relationship between alcohol and gray matter in the high methylation group.These findings suggest that TLR4 methylation may be protective against the damage conferred by alcohol on precuneus and inferior parietal gray matter, thereby implicating TLR4 for further investigation as a possible AUD treatment target.
View details for DOI 10.15288/jsad.2017.78.696
View details for Web of Science ID 000411534200007
View details for PubMedID 28930057
View details for PubMedCentralID PMC5675420
An Exploratory Association Study of Alcohol Use Disorder and DNA Methylation
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH
2016; 40 (8): 1633–40
Epigenetic factors, including DNA methylation, play an important role in the etiology of alcohol use disorders (AUDs). Noncandidate-based methylome-wide studies leveraging multiple tissue types are needed in order to identify a set of CpG targets that reliably differentiate AUD patients from controls and strongly correlate across brain tissue and more commonly collected tissue types (e.g., buccal cells).Postmortem precuneus brain tissue samples were collected from 49 alcohol-dependent (AD) cases and 47 controls (sample I), and DNA was extracted from precuneus and putamen brain tissue and buccal cells in 24 postmortem subjects (sample II). Methylation levels were analyzed at over 450,000 CpG sites in both samples. CpGs that demonstrated significant methylation differences between cases and controls were advanced for further analysis with the goal of identifying CpGs that also demonstrated consistent methylation correlations across tissue type.In the primary analysis, 244 hypomethylated and 188 hypermethylated CpGs met a priori criteria for both significant methylation differences between cases and controls as well as significant correlation across brain and buccal cell tissue types, employing stringent Bonferroni p-value correction. Many of these CpGs were involved in gene networks related to lipid metabolism, immune response, inflammatory response/disease, and gastro-intestinal disease.More than 400 CpGs demonstrated differences in methylation between AD cases and controls and showed significant correlation across tissue types. Several genes and pathways (e.g., inflammation and immune functioning) that have been previously associated with AUD were identified in the current analyses.
View details for DOI 10.1111/acer.13138
View details for Web of Science ID 000380729300007
View details for PubMedID 27388583
View details for PubMedCentralID PMC5108727
Negative and Interactive Effects of Sex, Aging, and Alcohol Abuse on Gray Matter Morphometry
HUMAN BRAIN MAPPING
2016; 37 (6): 2276–92
Chronic alcohol use is associated with declines in gray matter (GM) volume, as is the normal aging process. Less apparent, however, is how the interaction between aging and heavy alcohol use affects changes in GM across the lifespan. There is some evidence that women are more vulnerable to the negative effects of alcohol use on GM than men. In the current study, we examined whether localized GM was related to measures of alcohol use disorder (e.g., AUDIT score) in a large sample (N = 436) of participants, ages 18-55 years, with a range of disease severity, using both voxel-based morphometry (VBM) and surface-based morphometry (SBM). We also explored whether GM associations with alcohol use disorder (AUD) severity are moderated by sex and age. Results showed significant negative associations between AUD severity and GM volume throughout temporal, parietal, frontal, and occipital lobes. Women showed more negative effects of alcohol use than men for cortical thickness in left orbitofrontal cortex, but evidence for increased vulnerability based on sex was limited overall. Similarly, a specific age by alcohol use interaction was observed for volume of right insula, but other regional or global interactions were not statistically supported. However, significant negative associations between heavy alcohol use and GM volumes were observed as early as 18-25 years. These findings support that alcohol has deleterious effects on global and regional GM above and beyond age, and, of particular importance, that regional associations emerge in early adulthood. Hum Brain Mapp 37:2276-2292, 2016. © 2016 Wiley Periodicals, Inc.
View details for DOI 10.1002/hbm.23172
View details for Web of Science ID 000382486500020
View details for PubMedID 26947584
View details for PubMedCentralID PMC4867295
- The cannabis conundrum: Thinking outside the THC box JOURNAL OF CLINICAL PHARMACOLOGY 2015; 55 (8): 839–41
- Developing Neurobiological Endophenotypes that Reflect Failure to Control Alcohol Consumption and Dependence Current Addiction Reports 2014; 1 (2)