Elizabeth Twamley - US grants

DESCRIPTION (provided by candidate): The primary goal of this five-year training award is to further develop Dr. Elizabeth Twamley's expertise in the following areas: 1) work rehabilitation for individuals with schizophrenia and related disorders; 2) applied neuropsychological research, focusing on the relationships between neuropsychological test performance and everyday functioning, particularly work abilities; and 3) clinical trials research design, methodology, and statistical analysis that can be used to evaluate these relationships. Her overarching career goal is to bridge neuropsychological and interventions research for persons with severe mental illness. The proposed career development plan builds on her doctoral training in clinical psychology, her specialty training in clinical neuropsychology, and her research background in neuropsychology and schizophrenia. The proposed training plan will include structured coursework and regular mentoring from experts in the fields of psychiatric work rehabilitation, neuropsychology, geriatric psychiatry, and schizophrenia research. The training plan is complemented by a research project designed to evaluate the efficacy of a work rehabilitation program for middle-aged and older individuals with schizophrenia. Few of these individuals work, yet about 40% desire paid employment or volunteer work. A type of work rehabilitation called Individualized Placement and Support (IPS), which has achieved the status of evidence-based practice for younger individuals, will be prospectively studied for the first time in a randomized controlled trial for middle-aged and older patients. Retrospective data comparing older schizophrenia patients in IPS programs with those in conventional work rehabilitation programs have shown rates of paid employment to be 69% vs. 29%, respectively. The proposed research will address the IPS program's differential effects on work activity, psychiatric symptoms, functional capacity, and quality of life, as well as cognitive, demographic, and clinical predictors of successful work outcomes. The results of the study will be useful not only in establishing the efficacy of IPS for middle-aged and older consumers, but also in illuminating the relationships between neuropsychological performance, work-related functional capacity, and ultimate work outcomes in this population. Together, the training and research plan will allow Dr. Twamley to transition from a postdoctoral research fellow to an independent investigator in the UCSD Department of Psychiatry, and will provide the foundation for a research career focused on cognition and work rehabilitation for individuals with severe psychiatric disorders.

[unreadable] DESCRIPTION (provided by applicant): Occupational disability is one of the most devastating and costly consequences of severe mental illness (SMI). Supported employment programs such as Individual Placement and Support (IPS) are the most effective way to help people with SMI obtain competitive employment (i.e., "regular jobs" in the community). However, many clients in supported employment either do not work at all or fail to keep their jobs. The cognitive impairments and everyday functioning skills deficits of psychiatric disorders contribute to poor work outcomes, but they are modifiable with Cognitive Training. Pilot data support the effectiveness of IPS and Cognitive Training for clients with SMI, including those who are middle-aged and older. The proposed research aims to evaluate the effectiveness of augmenting IPS supported employment services with a 3-month Cognitive Training program that aims to improve attention, learning, memory, and problem-solving abilities. The Cognitive Training approach is compensatory, in that it teaches strategies for overcoming cognitive deficits, and aims to help clients develop better thinking and memory habits that will last a lifetime. In the proposed 24- month randomized controlled trial, 152 participants with SMI will receive either IPS with Cognitive Training (IPS-CT) or IPS with enhanced support (IPS-ES). The IPS vocational specialist will deliver the Cognitive Training intervention in the client's community setting of choice, along with standard IPS services (job searching, job development, and follow-along job supports). IPS-ES will control for the additional time and attention provided in the IPS-CT condition during the first 3 months. All participants will be followed for 24 months, and employment data will be collected weekly. The primary aim of the study is to evaluate the hypothesis that compared to IPS-ES, IPS-CT will result in improved cognition, functional skills, work outcomes (e.g., number of weeks worked), and quality of life. Secondary aims are to investigate the mechanisms underlying such improvements and to identify predictors of employment outcomes. If Cognitive Training is found to improve outcomes in supported employment, the psychiatric rehabilitation field will be better prepared to help clients across the age spectrum meet their vocational and community reintegration goals. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Identifying treatments to reduce the negative symptoms associated with schizophrenia is of high public health significance, due to the relationship between negative symptoms and poor functioning and quality of life, and the lack of effective treatments for negative symptoms. There is also a need for treatments of cognitive impairment to improve daily functioning in schizophrenia. Pharmacologic treatments for negative symptoms and cognitive/functional impairment have largely failed, but psychosocial treatments have been moderately effective. Two interventions, Cognitive Behavioral Social Skills Training (CBSST) and Compensatory Cognitive Training (CCT), show promise for treating negative symptoms (Granholm et al., 2005, 2007, 2012; Twamley et al., 2008, 2012), along with other symptoms, cognition, and functioning. Because of the significant effects of both CBSST and CCT on negative symptoms, we aim to develop a combined CBSST-CCT intervention specifically targeted toward negative symptom reduction, and to gather pilot data regarding its efficacy. CBSST (Granholm) and CCT (Twamley) are both manualized, group-based interventions that can be delivered in community settings to enhance generalization of training effects. CBSST combines elements of Cognitive Behavioral Therapy with Social Skills Training, two of the evidence-based treatments for schizophrenia. CCT uses compensatory strategy training and habit learning to improve cognition and everyday functioning. Both interventions have significant but moderate effects on negative symptoms (e.g., .4 at follow-up). The proposed project will bundle and refine a combined CBSST-CCT intervention to strengthen their impact on negative symptoms in schizophrenia and will test this combined intervention in a pilot randomized controlled trial comparing CBSST-CCT with a goal-focused supportive contact (SC) control group. We propose to randomly assign 64 participants with schizophrenia with persistent negative symptoms to one of the two treatments for 9 months, and follow them for 3 months after treatment. The primary goal of this project is to obtain feasibility and effect size data regarding this new intervention in order to plan a larger trial of CBSST-CCT. The primary outcome is negative symptom severity, and secondary outcomes include cognitive performance and everyday functioning. We will also examine mechanisms that mediate reduction in negative symptom severity in CBSST- CCT, including defeatist beliefs, cognitive and social skills, and pupillary responses during cognitive and social tasks (a biomarker of goal-directed effort allocation).

Project Summary This is an application for a 5-year renewal of the T32 Fellowship Program in Geriatric Mental Health at the University of California San Diego (UCSD). As the population ages, the demand for independent investigators in geriatric mental health will continue to increase. Over the last 15 years, we have trained 71 T32 trainees including 40 postdoctoral Fellows, 14 predoctoral Fellows, and 17 medical and pharmacy students. This T32 program, continuously funded since 1994, is part of a larger research training program within UCSD?s Division of Geriatric Psychiatry. It is also affiliated with the UCSD Center for Healthy Aging, Sam and Rose Stein Institute for Research on Aging, and UCSD?s Clinical and Translational Science Award (CTSA). Over the past 5 years, 68% of our predoctoral and postdoctoral trainees have been women, 37% have been people of color, and 16% have been from Under-Represented Minority (URM) ethnic groups. All have completed at least two years of Fellowship training or are still in training, and all are continuing in full-time academic activities. All trainees with at least one year in the program have published multiple peer-reviewed papers. Our postdoctoral trainees have obtained 5 K awards or VA Career Development Awards in the past 5 years, and previous Fellows have obtained funding from NIH, VA, Department of Defense, as well as support from various foundations. We place major emphasis on career development, both for mentees and mentors. The Fellowship program includes individual mentoring along with experiential training in team science, complemented by didactic activities. A personalized Individual Development Plan (IDP) is created with each trainee early in the course of the Fellowship. Writing and statistical skills enhancement, guidance on balancing personal and professional obligations, and exposure to cross-disciplinary co-mentors and collaborators characterize our program. This renewal application proposes to support 5 postdoctoral Fellows (optimally, a combination of PhDs, MDs/MD-PhDs, and PharmDs), 2 predoctoral students (in clinical psychology or neuroscience), and 2 summer research slots for pharmacy students annually. Over the next 5 years, we will increase our focus on technology and engineering in aging and mental health, including mobile health and data science technologies to improve assessment, treatment, and service delivery for older adults with psychiatric illnesses. We will also continue to emphasize translational and basic neuroscience, positive psychiatry, physician and pharmacist scientists, diversity of trainees, and research on training. We have developed a strong plan for evaluation of the training process including short-term, intermediate-term, and long-term outcomes, including research productivity for Fellows and professional advancement for mentors.

The goal of this project is to create human-centered robotics technology to provide personalized neurorehabilitation to support older adults with mild cognitive impairment. The project investigates innovative approaches to this research area, and will make the following contributions to smart and connected health: create new approaches to support longitudinal, personalized robot learning in real-world environments; pioneer novel methods for delivering and sustaining cognitive neurorehabilitation, currently one of the only known treatments to prolong independence and slow the onset of disability caused by MCI; and contribute new methods to the fields of human-robot interaction (HRI), aging science, and behavioral science to support the co-creation of new technologies and new intervention delivery methods with older adults with cognitive impairments, their caregivers, and their providers. Harnessing technology to provide cognitive support and rehabilitation for older adults could potentially assist millions of people to maintain or improve their functioning and quality of life, and maintain their ability to live independently. Ultimately, these improvements could alleviate significant human suffering and lower healthcare costs for millions of people.

This project will inform multiple key research questions including: uncovering new methods for longitudinal preference learning, particularly with regard to how time-varying contextual bandits under concept drift can be employed across multimodal datasets; identifying principles for engaging in community-focused, stakeholder-centered research with people with MCI, with a particular focus on designing for resilience and autonomy; discovering how hybrid approaches to cognitive training delivered via a robot can inform cognitive functioning; and exploring how to design interventions for sustainability, both for people with MCI and other populations. The project team will also engage the public in intergenerational research between older adults and college students, empower older adults with cognitive impairments and their family members by giving them a voice in technology creation, recruit research students from groups underrepresented in computing and behavioral science, and broadly disseminate the research via publications, representations, and publicly available software frameworks with models, algorithms, and evaluation metrics.

This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.