I'm June Gruber an associate professor of psychology at the university of Colorado Boulder and the director of this mental health experts series. I'm delighted to be here today with Dr. Katie McLaughlin, the John L. Loeb, associate professor of the social sciences and the department of Psychology at Harvard University about her groundbreaking work on stress, trauma, and risk for psychopathology. Thanks for being with us today. My pleasure. Thanks for having me. I was wondering if you would start just by telling us a little bit about the mental research you do. Absolutely. The work that we do in my lab is focused on understanding how experiences of adversity in childhood ultimately come to place children at risk for mental health problems later in life. We know that, if all of the risk factors that exist for developing mental health problems like depression, anxiety, externalizing problems, substance abuse, one of the most powerful, is having experienced an extreme stressor, a traumatic event or another form of adversity in childhood. We've known that that association exists for a long time. But one of the things we don't understand very well is why? Why is it that experiencing stress and adversity in childhood has such a powerful impact on mental health? Where the mechanisms are the pathways through which those early experiences come to shape risk for psychopathology. My lab is really focused on that question, understanding the how and why of that relationship. That's wonderful. Just as you're saying, such fascinating work to look at the origins of where psychopathology first horizons and the pathways through which it progresses. One of the questions I had in hearing about your work was just wanting to learn a little bit more about how you first got started in doing this work. It's a great question. I actually love when people ask me about this because I came into this research question [inaudible] an indirect way. When I was a graduate student, I was really interested in this idea that we might be able to prevent people from developing mental health problems before they ever emerge in the first place. We've learned so much about how mental health problems tend to be chronic once they emerge. For example, once you've developed depression it places you at risk for developing another depressive episode later. I thought it would be really important from a public health perspective to think about how could we prevent these mental health problems from emerging in the first place? Where that line of thinking took me was, what are the things that we understand about the early experience in the early environment that are the most powerful predictors of who goes on to developmental mental health problems. Because that's where we should be looking and to think about how we can prevent these problems from emerging in the first place. That path took me very quickly to childhood adversity as I said earlier, if you hadn't noticed one thing about somebody and you wanted to make a guess about whether this person was likely to develop cytopathology. That one thing you'd probably want to know is did this person experience trauma or adversity in childhood? After thinking, this would be a good place to really focus our attention as a field in terms of thinking about prevention. I quickly learned that we don't actually understand very well why it is that experiencing trauma or other forms of adversity in childhood is still likely to lead to mental health problems. What are factors that promote resilience to those mental health problems in kids who have experienced adversity. My research program really began to explore those questions with an eye towards understanding these pathways and mechanisms so that we can develop better preventive interventions. One of the more exciting things that we've been working on, and we've spent the last decade really investigating these questions about mechanisms and developmental pathways, I feel like we finally started to learn enough about what some of those key mechanisms are to develop a preventive intervention. In collaboration with my colleague John Weisz at Harvard, we are developing and just about to start pilot testing, a new model of thinking about preventing mental health problems in kids who have experienced adversity so that's something we're very excited about. I mean, that is really exciting and as I hear about, your whole career trajectory, just what powerful insights the work you're doing is really telling us about who goes on to be more or less vulnerable to developing, as you're saying, mood, anxiety, and other domains of psychopathology. Just when you reflect on your career, when you first started and where you are now. What have been some notable, both frustrations or failures along the way, but also success was that you've really savored? I appreciate that question and when I talk to graduate students and young people in the field, people are interested in becoming psychologists. I always like to start by saying that my path towards this research question started with a giant failure and that was my dissertation study. Once I had come to this conclusion that where we should be thinking about for prevention is targeting kids who experience adversity. I developed preventive intervention as a graduate student and I tested it out in a large sample of kids, and it totally failed. It didn't work at all. It was completely ineffective and that was one of the most powerful learning experiences for me. What I was doing at the time was basically taking our treatment model of a trans diagnostic cognitive behavioral therapy approach and thinking we could just apply that same lens to kids who hadn't developed mental health problems yet and it should work just as well as it works as a treatment. That turned out to be not true at all. It really made me step back and start to think about, what exactly is it about the early environment and these experiences of adversity? What does that changing about the way kids develop? That puts them on this trajectory that places them at a greater risk for psychopathology because that's where we need to target our interventions and where that's led me is really a different place than where I started in my thinking. That early failure experience, was very powerful and very important for me to take a step back and really think about how do we get from point a to b in terms of early experience and then psychopathology to develop better interventions to target those pathways. As you look forward and think about your own experiences, learning experiences along the way, how does that shape what you see now is the most important next steps for the field? To reiterate the aspect of my work that we're most excited about is really that translation of the basic knowledge that we've developed about how experiences of adversity early in life are altering developmental pathways for kids in ways that are likely helping them adapt to those contexts they're developing in, but in the long-term, maybe placing them at risk for psychopathology, and thinking about how we can target those pathways in interventions that are brief and that are likely to be scalable. One of the big mistakes I think I also made in my early thinking about this was this idea that we can take a long, maybe 12 to 16 session, treatment approach and just deliver it early and that would help kids and that would prevent psychopathology. The reality is that a lot of people don't have access to our best evidence-based treatments. There are enormous disparities and access to good quality mental health care and what we need to be thinking about as a field, at least in my view, is not only how do we prevent these problems from emerging in the first place, but how did we provide interventions that are going to be accessible, that are not going to have the disparities in access associated with them that many of our evidence-based treatments do, and how can we get these interventions into the hands of the people who are working with the people who need them the most. Just as an example, in the work that we're doing, we're actually implementing this prevention program in the context of pediatric primary care. We are borrowing tools that have been developed within primary care settings to screen children for adversity, just using their parent's reports when they come in for a routine pediatric primary care visit and then trying to deliver that intervention within the context of routine pediatric primary care, where both people may feel more comfortable coming back to talk to somebody about these experiences than seeking out, for example, a mental health professional, and where families may be able to access these services more easily than where their traditional [inaudible] have been made available. It's incumbent on us as psychologists not only to continue developing more effective approaches to prevention but making sure that those approaches are accessible to the people who really need them. In thinking about accessibility to the people who may need these interventions the most, what advice would you have for others, maybe those watching this interview today, whether they're students, public mental health professionals who might be interested in getting involved in the field? I would say in terms of advice about thinking about how we can have the biggest impact. We're really at a pivotal moment in our society and for the field to be thinking outside the box in terms of our traditional approaches. In terms of mental health therapy, our traditional approach is, you've got one clinician and one client who comes to see that person and they sit there and they talk for an hour, every week for a couple of months at least. That's what we call psychotherapy and that's how our interventions look. I think that what we've learned is that those interventions can be amazing and very powerful for the people who can access them, but that's not a model that works for a lot of people. How can we think really outside the box? [inaudible] One thing we're doing in this intervention just as an example. It's interesting, the pandemic is actually one of the things that really triggered us to do this. Originally, we were thinking about using home visiting, so families would be identified within primary care, but then the intervention would be delivered in their homes, which is actually something that's been really effective in public health models of prevention, like Nurse-Family Partnership for high-risk families right after they deliver a new baby. Then the pandemic hit and we thought, well home visiting is going to be a challenge for us right now. Let's think about why couldn't we do this intervention digitally or some combination once the pandemic is over, bringing the intervention to people's homes, reducing that barrier for them to access this intervention, as well as delivering it the way that you and I are speaking right now for families who would prefer that who maybe don't want somebody coming to their house that would be open to interacting through digital technology. What I would encourage is for people to think outside the box of our traditional ways of viewing mental health interventions and really think about how we can meet people where they are and help face the enormous challenges that many families are experiencing right now is when it comes to mental health, especially since the pandemic has started. Well, thank you so much for that really eloquent and powerful answer, and also for taking the time to speak with us today. It's my pleasure. Thanks for having me.
