My research program is centered on translating findings from cognitive, affective, and social neuroscience into novel interventions (e.g., mindfulness training) that effectively target transdiagnostic mechanisms underpinning stress-related, biobehavioral conditions such as substance abuse/dependence, chronic pain syndromes, and cancer survivorship. I have a broad background in interdisciplinary clinical research on psychosocial interventions for stress-related conditions, with specific training and expertise in biobehavioral research methodologies. I was trained in intervention research at the University of North Carolina at Chapel Hill, where I completed my PhD in Social Work and was awarded Ruth L. Kirschstein pre- and post-doctoral fellowships in integrative medicine from the National Institutes of Health to conduct clinical trials at the University of North Carolina at Chapel Hill School of Medicine.
Current Research Projects
MORE for Chronic Pain and Opioid-Related Problems.
I am Principal Investigator on a $670,500 R34 grant funded by the National Institute on Drug Abuse (NIDA) entitled, “Targeting Military Opioid Misuse with Mindfulness-Oriented Recovery Enhancement.” Soldiers with chronic pain undergoing long-term treatment with opioid analgesics are at risk of misusing prescription opioids and developing opioid addiction. Mindfulness training interventions have been shown decrease chronic pain symptoms, stress, and addictive behaviors. The objective of this project is to test a mindfulness-oriented intervention designed to prevent development of prescription opioid addiction among soldiers with histories of chronic pain and opioid misuse.
This project builds upon my recently completed NIDA-funded project, “Mindfulness-Oriented Recovery Enhancement for Chronic Pain Patients Receiving Opioid Therapy: Exploration of Cognitive, Affective, and Physiological Mechanisms.” Prescription drug abuse has reached epidemic proportions in the U.S., and presents a significant threat to public health. Individuals suffering from chronic pain who are treated with long-term opioid therapy are at risk of misusing prescription opioids and developing opioid addiction. Hence, the objective of this randomized controlled trial was to test the efficacy of MORE as a means of decreasing pain, opioid craving, and opioid misuse behaviors among persons with chronic pain disorders who are dependent on or misusing opioid medication. Moreover, I used advanced psychophysiological methods (e.g., measurement of autonomic nervous system and brain activity) and tasks from cognitive neuroscience to assess how these clinical outcomes might be mediated by changes in mechanisms such as hypervigilance for pain- and drug-related cues, emotional reactivity, and impulse control. Study findings were positive in favor of MORE as a treatment for this issue and were published in 2014 in the prestigious Journal of Clinical and Consulting Psychology. Findings concerning the cognitive, affective, and psychophysiological mechanisms of the treatment were published in 2013 in Psychotherapy and Psychosomatics, in 2014 in Psychopharmacology, and in 2015 in the Journal of Behavioral Medicine.
Mind-Body Interventions in Supportive Oncology and Survivorship
As Associate Director of Integrative Medicine in the Supportive Oncology and Survivorship Program of the Huntsman Cancer Institute, I have begun research on the therapeutic effects of mind-body interventions for cancer and their mechanisms of action. New research efforts are focused on mindfulness training, yogic breathing, guided imagery, and clinical hypnosis, among other interventive techniques. This area of research is particularly fertile ground for studies on the cognitive, affective, and psychophysiological pathways linking mindfulness to positive reappraisal coping, the capacity to find meaning and purpose in the face of adversity.
Mindfulness and Positive Emotion Regulation.
I am pursuing experimental research in the laboratory, as well as observational studies and clinical trials, to explore the effects of mindfulness on positive emotion regulation. Specifically, I am interested in how mindfulness and related psychological factors may influence two key positive emotional processes: positive reappraisal coping and savoring. These forms of positive emotion regulation are closely linked to mental health and well-being. Finding ways to promote these processes may be the key to ameliorating conditions that involve reward dysregulation (i.e., being unable to receive pleasure healthful objects and events in the natural environment – think smiling babies and sunsets) such as addiction and chronic negative mood states. This line of research informs my theory development efforts.
Cognitive, Affective, and Psychophysiological Mechanisms in Health and Mental Health.
I also study basic cognitive, emotional, and psychophysiological processes implicated in mental health problems and addiction. For instance, I conduct research on the attentional bias – that is, the phenomenon by which people more rapidly detect and focus on objects and events that are congruent with their current mood than those that are not congruent with their current emotional state. Thus, individuals in a negative mood state tend to pay attention to objects, persons, and events that they construe as disappointing, upsetting, or frightening, while overlooking or ignoring what is beautiful, affirming, or pleasurable. Attentional bias is particularly evident in addiction when addicts are “triggered” and find their attention automatically captured by drug-related cues (such as the sight of a cigarette, pill, or bottle of liquor) even when they want to stay clean and sober. I am also interested in studying how the brain modulates the heart beat when people are paying attention to emotional stimuli and experiences. My studies and the studies of others have shown that rapid, beat-to-beat changes in heart rate, known as heart rate variability, are significantly associated with emotional states and degree of mental focus.
Inhalant Misuse Phenomenology, Epidemiology, and Intervention.
With Dr. Matthew Howard at the University of North Carolina at Chapel Hill, I conduct epidemiological research on the causes, correlates, and consequences of inhalant misuse. Through our research, we have found that a significant number of inhalant users inhale volatile substances like gasoline and computer duster spray as a means of self-medicating negative emotions and trauma (in addition to seeking their intensely euphorigenic effects). We intend to use what we have learned about the phenomenology and patterns of inhalant misuse to guide the development of new, multimodal treatments for people with inhalant use disorders.
Past Research Projects
Mindfulness Training for Irritable Bowel Syndrome.
In my fellowships, I took part in the development and implementation of a randomized controlled trial funded by the National Center for Complementary and Alternative Medicine of a mindfulness training intervention for women irritable bowel syndrome. I helped to develop the control group (i.e., a support group) protocol, and assisted in study implementation. When the study was complete, I spearheaded multivariate analyses to identify the therapeutic mechanisms of mindfulness on chronic abdominal pain. To this end, I utilized my advanced statistical training in structural equation modeling and latent growth curve analysis. Study results demonstrated that mindfulness training led to an over 30% reduction in IBS symptoms following treatment, a statistically and clinically significant change in outcome for an often-intractable condition that may cause great suffering and disability.
MORE for Alcohol Dependence.
During my fellowships and as PI on several private foundation and university-funded grants, I carried out a randomized controlled trial of a mindfulness-oriented intervention for alcohol dependence, Mindfulness-Oriented Recovery Enhancement (MORE), and investigated the cognitive and psychophysiological mediators of clinical outcomes. Through this study, I developed expertise in measuring indices of attentional and autonomic nervous system reactivity, and designed and tested the first iteration of the MORE treatment manual.