CSR&D Research Career Development Transition Award Application

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There is an “epidemic of loneliness” with 20% of civilians and up to 50% of veterans reporting feeling lonely or socially isolated. This is clinically important because loneliness and social isolation are strong predictors of worse physical health and early mortality. Mental illness is intimately entwined with this epidemic because it both causes and is worsened by loneliness and social isolation. It is the social deficits of mental illness that most strongly contribute to loneliness and social isolation. These social deficits include difficulty understanding other people’s behavior and difficulty behaving appropriately in social situations. Despite their importance, these social deficits are poorly understood at the neural and behavioral levels and are difficult to quantify. Moreover, available treatments for them are inadequate. I am the Director of the Bonding and Attunement in Neuropsychiatric Disorders (BAND) lab, which comprises one junior faculty member supported by a CSR&D Career Development Award, 5 postdoctoral fellows including MDs and PhDs, 4 graduate students, 6 paid research assistants, over 20 volunteers. We believe the key to mental health and well-being starts with strong relationships. Our mission is to develop novel pharmacological and cognitive interventions for mental illness that enable patients to strengthen their connections to other people and the world. Our work has primarily focused on understanding the psychological, behavioral, physiological, and neural effects of administration of the neuropeptide oxytocin across multiple psychiatric illnesses. For example, we have conducted numerous studies determining the acute effects of oxytocin administration in individuals with schizophrenia. One highlight of this work is that we found that a single administration of oxytocin to individuals with schizophrenia normalized neural activity during high-level social cognitive processing and that this normalization was associated with improved behavioral performance. This work led to a VA CSR&D Merit Award to conduct the largest randomized clinical trial of repeated administration of oxytocin in schizophrenia to date. We have also conducted studies investigating oxytocin as a potential treatment for individuals with alcohol, opioid, and stimulant use disorders, and co-occurring post-traumatic stress disorder (PTSD) and alcohol use disorder (a common and difficult-to-treat comorbidity). We also recently completed a large laboratory-based study in healthy individuals to determine whether acute oxytocin administration can accelerate the development of team cohesion. This work led us to hypothesize that pharmacological treatments that affect social processes could be paired with psychosocial treatments to possibly achieve synergistically positive outcomes. To investigate this possibility, we have conducted studies pairing administration of various drugs with social effects, including oxytocin, 3,4-methylenedioxy-methamphetamine (MDMA), and psilocybin, with various psychotherapy interventions including group-based psychotherapy. In the non-pharmacological arena, we have been investigating attention bias modification delivered through a smartphone app as a treatment for PTSD. Our studies incorporate multiple analytic approaches including objective measures of social behavior such as eye-gaze, facial expressivity, team cohesion and performance, quantification of social cognitive abilities, neuroimaging approaches, laboratory-based craving induction paradigms, and quantification of psychophysiological changes and interpersonal synchrony. In sum, I have developed a broad and highly productive trans-diagnostic program of research and assembled a large, energetic, and multidisciplinary research group focused on developing and testing novel treatments for the difficult to treat social deficits that cut across most psychiatric disorders. By improving social deficits across disorders, veterans will have better social functioning and decreased symptom severity and will be able to more effectively mobilize their social support networks and engage in other psychiatric treatment. This will lead to better health outcomes and decreased costs for the VA health system.