The proposed research project proposes to develop and test a mobile intervention, Normalizing Orientation to Treatment and Help-Seeking (NORTH) designed to impact knowledge and attitudes to encourage help-seeking among young adults at risk for psychosis. This project involves (1) a needs assessment to understand barriers, interests and preferences related to mHealth and in-person treatment, (2) development, refinement and usability testing of NORTH, and (3) a pilot randomized controlled trial assessing feasibility, acceptability and preliminary efficacy compared to an active control mHealth intervention providing only stress management.
Practice Type: Online/remote/apps/social media
The PREDICT study: a personalized medicine approach to prazosin for PTSD
Prazosin, like many of our most effective treatments for PTSD, seems to be significantly more effective for some individuals than others. We have hypothesized that this is because prazosin works to compensate for increased noradrenergic signaling, which is a primary driver of symptoms in some, but not all, individuals with PTSD. If we could identify individuals where increased or inappropriate noradrenergic signaling is driving PTSD symptoms, it would not only help us match individuals with treatments that will work well for them, but would also help us identify new treatment options.
The PREDICT study is a 5-year clinical trial designed to (1) test whether clinically-relevant biomarkers can predict in advance who is most likely to benefit from prazosin for PTSD; and (2) test a working model of how pre-synaptic and post-synaptic changes in the regulation of noradrenaline may combine together to produce the symptoms of PTSD.
The ATTEND study for Healthcare Workers and First Responders
Healthcare workers and first responders working during the COVID-19 pandemic have experienced increased exposure to suffering and loss; prolonged work hours; and increased personal risk. Although associated increases in psychiatric symptoms and occupational burnout are well documented, what aspects of the experiences are most strongly associated with negative outcomes over time – and what interventions are most likely to protect healthcare workers and first responders – are poorly understood.
The ATTEND study is designed to address the impact of occupational stress related to working during the COVID-19 pandemic on health care workers and first responders (police, fire, EMTs) through a national longitudinal survey paired with a local interventional clinical trial. The interventional clinical trial is designed to test the impact of treating sleep disruption with prazosin during or shortly after the period of exposure.
Deploying a texting intervention for psychosis; from research to real-world practice
The vast majority of young adults with early psychosis own mobile phones, identify texting as their preferred communication modality, and report an interest in messaging-based treatments. We developed a texting intervention for people with psychosis called the Mobile Interventionist. Treatment is conducted via daily recovery-oriented text conversations between patients and a trained messaging practitioner. This novel form of engagement produces an asynchronous but continuous form of treatment and combines the advantages of digital health (i.e., accessibility, reach beyond the brick-and-mortar clinic, low intensity), with the flexibility, personal tone and sensitivity of a clinician. Several studies have demonstrated that our texting intervention approach is feasible, acceptable, engaging and effective. This initiative will help translate this promising research into real-world clinical practice by implementing the Mobile Interventionist texting model at the University of Washington’s Specialized Treatment Program for Early Psychosis (STEP).
Clinically, the intervention may improve the illness management of young adults with early psychosis participating in the pilot, improving their long-term trajectories. Programmatically, the pilot bridges the research/practice gap by providing training and guided clinical experience to a real-world clinical team.
Developing a digital platform to deliver family intervention for psychosis
The World Health Organization ranks psychotic disorders as the third most disabling health condition worldwide. Eleven million Americans will experience psychosis during their lifetime, and roughly 60 million Americans have a loved one affected by psychosis. Research affirms that psychotherapeutic interventions can help family caregivers develop skills to better connect and communicate with their loved one, which corresponds to better treatment engagement, symptom improvement, fewer hospitalizations, improved functioning, reduced substance use, reduced mortality and overall improvement in quality of life for the individual with psychosis. Family interventions are therefore critical to a holistic and effective clinical response to a psychotic disorder. Nevertheless, a recent federal investigation found that fewer than 2% of US families caring for someone with psychosis had received a family intervention for psychosis.
Psychosis REACH (Recovery by Enabling Adult Carers at Home) is a family intervention for psychosis co-developed by faculty in the UW Department of Psychiatry and Behavioral Sciences that delivers psychoeducation and illness management skills training to family caregivers in the community. To enhance broad and equitable access to tens of millions of families and caregivers, this project will develop “Psychosis iREACH,” a digital platform that uses Artificial Intelligence (AI) technology to deliver Psychosis REACH to diverse families navigating psychosis. A virtual coach will assist families to access self-management skills practice, automated self-assessment, tailored training goals and individualized learning trajectories whenever and wherever families need the support. Psychosis iREACH represents a multidisciplinary collaboration among faculty in the School of Medicine, School of Nursing and School of Science, Technology, Engineering & Mathematics.
Using technology to scale Caring Contacts and reduce suicide
On top of climate change, political divisiveness and cultural turbulence, we have faced the most devastating pandemic since global influenza 100 years ago. The resulting social and economic stresses have manifested as widespread anxiety, a worsening opioid epidemic and the highest suicide rates in decades.
Proven behavioral health strategies like Caring Contacts offer hope. Caring Contacts is a program where suicidal individuals receive periodic letters or text messages from a behavioral health practitioner, creating a connection and showing someone cares. Caring Contacts have reduced suicide deaths, attempts and thoughts of suicide and offer an easy re-connection to healthcare, but behavioral health practitioners are in high demand and short supply and often struggle with prioritizing messages and sending timely replies. By analyzing a patient’s text messages, computerized algorithms can identify indicators of risk and other important information to help behavioral health practitioners with the nature and timing of their responses, allowing one behavioral health practitioner to reach hundreds of suicidal patients.
This project brings together behavioral health care, mobile technologies that people now expect and innovative informatics methods to identify critical signs of suicide risk that busy practitioners may miss. Our team consists of experts in behavioral health, usability and design, artificial intelligence/natural language processing, software engineering, health care information systems and emergency medicine. Our goal is simple: to use technology to provide critical support for those in crisis, and to save lives.
Leveraging peer mentor texting to support maternal wellbeing in the perinatal period
Perinatal mood and anxiety disorders affect one in seven pregnant and postpartum women nationwide, making them the most common complication of pregnancy. Unfortunately, only one in 20 women who need treatment for these conditions actually receives it. This translates to a multigenerational issue, which can negatively affect the mother and child’s long-term physical, emotional and developmental health. It also means an estimated $14.2 billion annually in societal costs in the U.S. alone. While not every perinatal individual with mental health concerns has access to a mental health provider, cell phones and text messaging are ubiquitous. Nonjudgmental support delivered through text messaging may be a low cost approach to reaching women who need emotional support in the perinatal period.
Our project aims to evaluate a text-based mentoring program, the Nurture Program, and assess whether it is possible to support mothers through their third trimester of pregnancy and nine months postpartum and enhance their emotional well-being. The Nurture Program combines the convenience of secure text messaging with the personalization of having a trained peer mentor with whom the mother can develop a trusting relationship. This program also provides resources on child development, connections to local support agencies and suggestions for parent-child bonding and parental wellness activities. Surveyed participants of the Nurture Program consistently report their mentor helped them feel less stressed and more confident in their role as a parent. This study will allow us to measure the impact of this cost-effective approach to promoting perinatal emotional well-being.
The RECOVER study: testing online platforms to identify patients with persistent post-COVID symptoms
After COVID infection, 10-50% of people experience persistent symptoms such as fatigue, palpitations, insomnia, cognitive problems, and headache – often with significant associated distress and functional impairment. The exact combination of symptoms varies from person to person, and it is expected that the specific causes vary from person to person as well.
Because of this variability, the current recommendation is for an evaluation by a multidisciplinary team. This creates a demand on our medical system that far outstrips current resources, and risks exposing patients to long, complex medical evaluations whose results are hard to interpret. In addition, clinical treatment trials that mix patients with similar symptoms but different underlying causes have high failure rates.
To address these challenges, a team of investigators including Rebecca Hendrickson, MD, PhD (Department of Psychiatry and Behavioral Sciences), John Oakley, MD, PhD (Department of Neurology), and Aaron Bunnell, MD (Department of Rehabilitation Medicine) are testing an online platform to identify patients whose pattern of symptoms suggest a particular underlying cause that is common after certain physiologic (i.e. illness or injury) and psychological stressors: increased adrenergic (adrenaline/noradrenaline) signaling in the brain and peripheral nervous system. We will pair this with a smaller number of detailed in-person assessments to validate our symptom-based measures and characterize associated biomarkers.
Our results will provide a detailed assessment of the patterns of symptoms caused by high amounts of adrenergic signaling that are seen in persistent post-COVID syndrome, how they change over time, and their association with objective measures of cognition and physiology. The project will provide the information needed to begin clinical treatment trials using existing, well-tolerated treatments that modulate adrenergic signaling. We hope the results will also have strong relevance to other potentially related disorders such as Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia.
