Discovery and Innovation in Women’s Mental Health
McLean’s research efforts support girls and women across the life span.
Research into women’s mental health aims to help pinpoint the unique ways in which psychiatric disorders affect women and girls. By focusing on how mental health disorders affect women and girls, investigators work to find new causes and cures, with the goal of improved treatment outcomes.
“It is only since the late 1990s that women were included in medical research,” according to Shelly F. Greenfield, MD, MPH, chief of McLean’s Division of Women’s Mental Health. “And these newer studies reveal that many diseases do have specific sex and gender characteristics, etiologies, and treatments.”
McLean maintains the largest neuroscience and psychiatry research program of any private psychiatric hospital in the U.S. Our neuroscientists and clinician-researchers contribute to the advancement of women’s mental health research through basic science and clinical research studies.
McLean is at the forefront of discovery in the field, with several pioneering efforts originating in our research programs.
Scientific Investigation at McLean
Lois W. Choi-Kain, MEd, MD, Gunderson Personality Disorders Institute Research Program
The major focus of Dr. Choi-Kain’s current research is access to care for patients with personality disorders. Recent research projects include an analysis across 21 countries that found a dearth of providers certified in “specialist” BPD treatments; and a meta-analysis of treatment-as-usual (TAU) arms in trials of BPD treatments that found mild-to-moderate symptomatic improvement, suggesting that TAU may be a viable treatment option for patients without alternatives.
Through meta-analyses of recent studies, Dr. Choi-Kain has examined smartphone applications for symptoms of BPD, finding that outcomes data using this form of intervention are not yet adequate to recommend them. She has also completed a meta-analysis of dropout rates in psychotherapy trials for BPD. This study showed an overall rate ranging from 23% to as high as nearly 30% when adjusting for publication bias.
While most patients with BPD complete psychotherapies, the concerning fact is that a quarter to almost a third of patients do not fit the treatment offered. Briefer, less intensive treatments, adjusted as a starting point of recovery, and a stepped care approach may be needed. More research is needed to discern what works in naturalistic, generalizable treatment environments.
Shelly F. Greenfield, MD, MPH, Alcohol, Drug, and Addiction Clinical and Health Services Research Program
Dr. Greenfield’s research focuses on a wide range of questions regarding development, implementation, quality, and financing of treatment services for substance use disorders in the U.S. and globally. Dr. Greenfield’s Alcohol, Drugs, and Addiction Clinical and Health Services Research Program focuses on four main areas: gender differences in substance use disorders; development of effective treatments for substance use disorders in special populations, such as women and people with substance use and co-occurring other psychiatric disorders; effective implementation of treatment services for substance use disorders; and public health efforts aimed at prevention and early detection.
Dr. Greenfield received two NIH/NIDA grants to develop and test the implementation of an effective group therapy for women with substance use disorders. The Women’s Recovery Group (WRG) therapy was designed for women with substance use disorders (SUDs) who are heterogeneous with respect to the substance(s) used (e.g., alcohol or drug), co-occurring psychiatric disorders, trauma histories, and age or stage of life (e.g., single, partnered, pregnant, parenting).
The WRG study was developed and tested in two clinical trials that demonstrated efficacy, participant and therapist satisfaction, and the feasibility of implementing the group in real-world clinical settings. These studies concluded that the women-focused WRG is efficacious and can be feasibly implemented in community-based clinical settings. The WRG can enhance clinical outcomes among women with substance use disorders. The WRG dissemination manual was published in 2016 (Treating Women With Substance Use Disorders: The Women’s Recovery Group Manual).
In addition to developing and testing a new group therapy (the WRG) for women with SUDs, Dr. Greenfield and her collaborators have investigated the implementation of screening, brief counseling, and pharmacotherapy for individuals with alcohol problems and tuberculosis in Russia; services for women with substance use and co-occurring psychiatric disorders; substance use and HIV risk behaviors; financing and quality care for children and adults with substance use disorders; gender differences in HIV risk behaviors in individuals with SUDs; and gender differences in technology acceptance in SUD treatment, among other studies.
Kristin N. Javaras, DPhil, PhD, Division of Women’s Mental Health
Dr. Javaras examines the role of stress and emotion in eating behaviors—including binge eating in individuals with eating disorders—with the goal of developing more effective treatments. She was awarded an NIH career development grant to examine the effects of acute stressors and negative emotion on food choice behavior and associated neural activity in young women with and without binge eating disorder.
Dr. Javaras’ epidemiological research focuses on identifying risk factors for eating disorders and obesity, including gender and sex differences in those risk factors. She recently published a study suggesting that general self-regulatory ability in childhood protects against the development of excess fat in the abdomen during adolescence in both boys and girls. Dr. Javaras has also developed a library of standardized food images to facilitate more rigorous research on eating behavior since existing food image libraries tend to include pictures that are low quality, unappealing, or unrecognizable to U.S. participants.
Milissa Kaufman, MD, PhD, Dissociative Disorders and Trauma Research Program
Dr. Kaufman received an R01 Research Project Grant from the National Institute of Mental Health (NIMH) to support a five-year study that will involve mapping the biology of dissociation. Dr. Kaufman has continued her study, “Evaluating the Neurobiological Basis of Traumatic Dissociation in a Cross-Diagnostic Sample of Women with Histories of Childhood Abuse and Neglect,” which uses a range of techniques to explore the effects of childhood abuse in women with PTSD and dissociative identity disorder (DID). The study, funded by private donors and an NIMH grant, has enrolled 150 women to date, many of whom have been recruited from our women’s trauma units at McLean. As an extension of this study, the team is collaborating with Jean King, PhD, Peterson Dean of Arts and Sciences, and her colleagues at Worcester Polytechnic Institute to examine the neural mechanisms of dissociation and suicidality, supported by a generous gift from National Council Member Harry Kasparian.
R. Kathryn McHugh, PhD, Stress, Anxiety, and Substance Use Laboratory
Dr. McHugh studies the role of stress and anxiety in substance use. As the recipient of the Sarles Young Investigator Award for two consecutive years, Dr. McHugh conducted several studies of benzodiazepine misuse, a problem that is under-studied and disproportionately affects women. She used both qualitative and quantitative methods to develop a new assessment tool for understanding motivations for benzodiazepine misuse.
She also identified important sex differences in the misuse of benzodiazepines, with women reporting greater psychiatric severity and use of benzodiazepines to address untreated or undertreated anxiety. Women also reported risky patterns of use that can heighten the probability of negative consequences, such as overdose.
These studies showed for the first time that benzodiazepines can elicit a strong conditioned craving response, much like other substances. Dr. McHugh’s preliminary data will be used to seek federal funding for this important public health topic.
Laura Payne, PhD, Clinical and Translational Pain Research Laboratory
Dr. Payne specializes in identifying neurobiological, behavioral, and psychological biomarkers related to pain, particularly menstrual pain in adolescents. Specifically, she is interested in identifying factors that are associated with the transition from recurrent to chronic pain in girls and young women. Dr. Payne has received several National Institutes of Health (NIH) grants to support research examining central pain mechanisms in adolescent girls and young adult women with menstrual pain. This year she worked with colleagues from Brigham and Women’s and Newton-Wellesley Hospitals to co-found the Boston Area Women’s Pain Collaborative, a multidisciplinary group of professionals with the shared goal of improving the lives of women in pain through research and clinical care. Also, Dr. Payne was appointed to the editorial board of Pain Medicine.
Dawn E. Sugarman, PhD, Division of Women’s Mental Health
Dr. Sugarman received a prestigious five-year career development award from the National Institute on Drug Abuse (NIDA) to study how to increase the engagement of women with opioid use disorder in treatment through the use of a digital intervention.
In May 2020, Dr. Sugarman was a panelist in the discussion “Digital Therapeutics: Current and Future Opportunities” at Mass General Brigham’s World Medical Innovation Forum, streamed virtually to 11,000 registrants representing 104 countries, 46 states, and 3,200 organizations.
Additionally, the results from her study of a gender-responsive, web-based intervention for the treatment of substance use disorders, funded by the Sarles Young Investigator Award, was published in the Journal of Women’s Health. She is also completing a study evaluating a web-based intervention with transitional-aged young women (18-25 years) admitted to McLean’s clinical services who are experiencing both mental illness and substance use.
Mary C. Zanarini, EdD, Laboratory for the Study of Adult Development
Borderline personality disorder (BPD) involves maladaptive symptoms or traits in affect, cognition, behavior, and interpersonal relationships. Led by Dr. Zanarini and founded in 1994, the Laboratory for the Study of Adult Development’s team of clinician-scientists includes some of the world’s leading experts on BPD.
Dr. Zanarini’s group was integral to the validation of BPD as a psychiatric disorder, meaning that it can be differentiated from other disorders, it runs in families, it has a known treatment response, its biological underpinnings are identifiable, and it has a known course and prognosis. Their work has also led to a now widely held theory of the etiology of BPD: that those with BPD have a vulnerable temperament or a hyperbolic temperament that is exacerbated by childhood or adulthood adversity.
Dr. Zanarini is currently the principal investigator of the McLean Study of Adult Development or MSAD—an NIMH-funded study of the long-term course of BPD, begun over 20 years ago. This study has changed the view of BPD from a chronic disorder to the serious mental illness with the best symptomatic prognosis.
Dr. Zanarini is also the principal investigator of an NIMH-funded, internet-based randomized controlled trial of an early form of treatment for BPD: psychoeducation. Results suggest that learning the latest information about BPD can reduce symptom severity and improve psychosocial functioning over a year of follow-up.
Dr. Zanarini has developed some of the most widely used diagnostic scales for diagnosing BPD and the most widely used instrument for assessing the evolution of symptoms over time. Additionally, a screening measure for BPD has been developed.
There are two versions of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD)—both of which were developed for use in treatment trials and both of which assess the severity of borderline psychopathology over time. The original version is a clinician-administered interview using a five-point anchored rating scale for each of the nine criteria for BPD described in DSM-IV/5.
More recently, Dr. Zanarini’s group has developed a self-report version of the ZAN-BPD (the ZAN-BPD-SRV), which also uses a five-point anchored rating scale for each of the nine criteria for BPD described in DSM-IV/5.