Projects

Establishing peer support programs in healthcare organizations

Adverse events can be common for healthcare professionals working in acute care settings, and distressing events can be associated with burnout. Peer support is one of many wellbeing programs that can provide individual support and drive organizational culture change around help seeking behaviors. I have published in the peer reviewed journals, such as Nurse Leader, and for high-impact outlets, such as the American Medical Association and Advisory Board, on my research and best practices for developing and sustaining peer support program to support healthcare professionals after adverse events or other stressful events at work. I have also presented on peer support at the leading industry conferences: CENTILE, the American Conference on Physician Health, and International Conference on Physician Heath. My research in this area has also addressed how to adapt peer support programs to meet changing needs, such as the distress associated with the COVID-19 pandemic and social justice issues. As a consultant to other healthcare organizations, I partner with wellbeing champions interested in learning best practices in launching and maintaining effective, well-utilized peer support programs. Consultation can include single session meetings or more intensive engagements with training workshops.

Peer supporter wellbeing in the pandemic

The pandemic has taken a toll on the wellbeing of many who work in healthcare. Peer supporters and the connections they make with their colleagues are essential to support the wellbeing of healthcare professionals who experience distress at work, but during the pandemic peer supporters themselves may be challenged with burnout, secondary traumatic stress, and lowered compassion satisfaction. This mixed-methods study (currently under review) reports on the wellbeing of peer supporters in the pandemic and the demographic risk factors for emotional exhaustion, secondary traumatic stress, and lowered compassion satisfaction. Qualitative analyses examined themes in the peer supporter needs and ideas to sustain their wellbeing through individual, program, and organizational-wide improvements.

Healthcare professional peer support in the pandemic

The COVID-19 pandemic has presented extraordinary demands, uncertainty, and stress among nurses, which take a toll on individual resilience and well-being. Leadership actions are necessary to protect and promote the psychological well-being of the nursing workforce. Nurse leaders have a responsibility to help reduce the harmful effects of our battle against this unprecedented pandemic. An essential element of a response plan to sustain well-being should be a formalized peer support network. This article outlines nurses’ experiences during the pandemic, describes peer support basics, offers best practices for peer support programs, and presents lessons learned from 2 mature peer support programs.

FitLink: Using technology to enhance supportive accountability and improve long-term weight loss maintenance

Our interventions for weight management very successfully promote weight loss in the short-term as individuals are engaged in-person, weekly groups. However, these treatments too often fall short of helping those who have lost weight keep it off in the long-term. This project seeks to improve long-term weight loss outcomes (encourage weight stability and limit weight regain) using novel, technology-powered coaching methods. Participants in the two conditions receive remote treatment via text messages and coaching phone calls during the long-term maintenance phase of their weight loss program. We are examining if coaching informed by real-time data from digital devices and wearables to track weight, physical activity, and eating behaviors can enhance supportive accountability and improve participants’ weight trajectories.

Smartphones for smarter eating: Elucidating eating behaviors, stress, and heart rate variability

This study sought to integrate mobile psychophysiological monitoring with ecological momentary assessment of stress and eating behavior to examine the relationship between autonomic nervous system flexibility, stress, and binge eating in a naturalistic setting. Studying how emotions and physiology impact eating behavior in real-time has substantial potential for just-in-time intervention using novel mobile technologies. This was my dissertation study and manuscripts from this project are in preparation and under review.

Mindfulness-based interventions for binge eating

This systematic review and meta-analysis compiled and reviewed a disparate literature on mindfulness- and acceptance-based treatments for binge eating such as mindfulness-based cognitive therapy and Acceptance and Commitment Therapy. Findings from published the meta-analysis supported overall effectiveness of these interventions to reduce binge eating with medium to large effect sizes.

Mechanisms of Acceptance-Based Behavioral Treatment (ABT) for weight loss

ABT has demonstrated superior weight loss outcomes relative to standard behavioral weight loss treatment (SBT), but little is known about ABT's mechanisms of action. This study examined physical activity-related mediators of treatment response in a randomized controlled trial of ABT versus SBT. Participants reported on their intentions for physical activity using daily ecological momentary assessment and wore an accelerometer to assess moderate-to-vigorous physical activity during baseline, mid-treatment, and end of treatment assessment periods. A theoretically-driven model analyzed mediation of the effect of treatment group on percent weight loss through sequential mediators (physical activity intentions to physical activity behaviors). Findings from this study support that ABT's effect on percent weight loss was partially mediated by increased intentions for physical activity, which lead to increased physical activity behaviors obtained by participants exercising on more days per week. A manuscript from this project is in preparation.

Pain in Veterans seeking behavioral weight loss treatment

Overweight/obesity and chronic pain frequently co-occur and demonstrate a bidirectional relationship. This study examined the relationship between pain and modifiable risk factors, such as eating behaviors and mental health symptoms in Veterans referred for behavioral weight loss treatment (MOVE!). Veterans with higher pain intensity reported higher global eating disorder symptoms, emotional overeating, night eating, insomnia severity, and mental health symptoms. A better description of the clinical characteristics of Veterans with pain who participate in MOVE! highlights their unique needs and may improve treatments to address pain in the context of weight loss treatment. Findings published in Appetite.

PTSD and health behaviors

Research supports that individuals with PTSD are more likely to engage in unhealthy behaviors like substance use, but less is known about how they perform healthful behaviors like healthy diet and exercise and the potential impact on health indicators. This project studied differences between individuals with and without PTSD across health indicators and engagement in health behaviors, both unhealthy and healthy. Results from the published study support that, compared to controls, individuals with PTSD are more likely to engage in unhealthy behaviors like alcohol use and having guilt after overeating, are less likely to perform healthful behaviors like eating fruits or exercising vigorously, and have significantly higher BMI.

Trauma exposure and health

Exposure to traumatic events like combat and military sexual trauma is an increasing concern for the physical and mental health of Afghanistan and Iraq War Veterans. The aim of this study was to examine how increasing trauma exposure (no combat, combat, combat and military sexual trauma) is related to physical and mental health indicators in Veterans seeking healthcare services. Findings from this project highlight the relationship between trauma exposure and poor health outcomes and the need to further study the mechanisms of trauma exposure on physical and mental health. Understanding the relationship between trauma exposure and health can better inform services and care for Veterans.

Salivary cortisol and cold pain sensitivity in female twins

This project examines the mechanisms that lead healthy individuals to develop increased pain sensitivity. We explore the role of the physiological changes associated with the HPA-axis in this process and how genetic and familial factors contribute to the cortisol-pain sensitivity relationship. Ultimately, this research helps uncover the etiology of chronic pain conditions and the genetic and familial determination of predisposing factors. One manuscript presenting data of baseline cortisol and pain sensitivity has been published, and another publication examining HPA-axis suppression and pain sensitivity has also be generated from this project.