My research is focused on cognitive and emotional risk factors for adverse outcomes such as suicidal ideation in obsessive compulsive related disorders (OCRDs). My research also focuses on applying technology to enhance assessment of and interventions for OCRDs. My work is currently supported by a Career Development Award (K23) from the National Institute of Mental Health. In addition to NIMH, my work has been funded by Harvard Medical School (Principal Investigator) and industry collaborations (co-Investigator). I was a 2019 recipient of the Association for Psychological Science’s (APS) Rising Star Award and runner up for the 2021 Anxiety and Depression Association of America's (ADAA) Donald F. Klein Early Career Investigator Award.
Using Technology to Enhance Assessment of and Interventions for OCRDs:
I am the Principal Investigator (PI) of an NIMH K23-funded Career Development Award (K23 MH119372) that aims to use smartphones as a tool for low-burden detection of acute risk in people suffering from body dysmorphic disorder (BDD). More specifically, we are using smartphone-based active data (i.e., ecological momentary assessment) and passive sensor data to detect negative emotion states in body dysmorphic disorder (BDD). We aim to use smartphone-detected negative emotions to predict acute risk for suicidal ideation and substance use behaviors in people suffering from BDD.
Complementing this work, I am also a co-Investigator on a series of industry collaborations to develop and test cognitive behavioral therapy (CBT) mobile apps for BDD, OCD, and related disorders. As co-Investigator and former Project Director on these studies, I have worked closely with our industry partners to create clinical content for the apps; develop the apps via user-centered design; make decisions about collection of passive and active mobile data to improve and personalize treatment; coordinate with Information Security to ensure data security; and direct clinical trials. Alongside our industry colleagues, I presented our planned research to the FDA for presubmission feedback and I serve as the clinical expert on the FDA risk management team for these digital interventions. The initial pilot trial of our CBT for BDD digital intervention suggests that it appears feasible, acceptable, and efficacious (Wilhelm, Weingarden et al., 2020a), pending more rigorous, randomized control research.
To enhance our understanding of technology-based mental health interventions, my colleagues and I have also reviewed the current state of the research (Wilhelm, Weingarden et al., 2020b), explored naturalistic patterns of engagement with smartphone-based CBT which may inform how to optimize smartphone treatments (Weingarden et al., 2020), and used passive smartphone and wearable data to detect disorder severity (Jacobson, Weingarden, & Wilhelm, 2019a), diagnostic status, and symptom change (Jacobson, Weingarden, & Wilhelm, 2019b).
Shame’s role within cognitive behavioral models and treatment of OCRDs:
Another line of my research has focused on the central role of shame within cognitive behavioral models and treatment of obsessive compulsive related disorders (OCRDs). Shame is a deeply painful emotion that leads people to withdraw and isolate from others. In graduate school, I published a comprehensive literature review of shame in OCRDs, mapping its empirical and conceptual roles across BDD, OCD, skin picking disorder, hair pulling disorder, and hoarding disorder (Weingarden & Renshaw, 2015). After noticing that existing measures of body shame were eating disorder-specific and did not capture body shame in the context of BDD, I developed a new measure of BDD-specific body shame and published a two-study manuscript testing its psychometric properties (Weingarden et al., 2016a). This measure enhances our ability to assess BDD-relevant body shame in research and clinical contexts. Moreover, we have very little information on whether existing empirically supported treatments for BDD effectively target and reduce shame. To this end, my colleagues and I investigated whether shame reduces with selective serotonin reuptake inhibitor (SSRI) treatment for BDD, an empirically supported treatment. Findings showed that levels of shame reduced significantly across SSRI treatment (Weingarden et al., 2018).
Emotion-Based Risk for Serious Health Outcomes in OCRDs:
Building off of my work on the role of shame in BDD, I have also published research demonstrating that shame and anxiety are critical risk factors for some of the most severe outcomes observed in BDD, including suicidal ideation, comorbid depression severity, housebound avoidance, and functional impairment. While shame has been linked with a wide range of adverse outcomes in the broad psychological literature, very little prior research had investigated shame as a risk factor in BDD or other OCRDs. My NIMH F31-funded dissertation showed that shame predicts suicide risk, depression, and functional impairment above and beyond anxiety in BDD and OCD, and that anxiety uniquely predicts depression and housebound avoidance above shame in BDD and OCD (Weingarden et al., 2016b). The relationships between shame and anxiety with adverse outcomes were stronger among BDD and OCD participants than among healthy controls. A second study demonstrated that, among BDD participants specifically, general shame is more strongly related to adverse psychosocial outcomes than is body shame (Weingarden et al., 2017). Having demonstrated shame’s iatrogenic role in BDD, I next investigated changes in adverse outcomes that correspond with changes in shame from SSRI treatment for BDD. This study showed that reductions in shame across SSRI treatment predicted reductions in suicidality (β = .39) and hopelessness (β= .41), when controlling for reductions in BDD severity and depression severity (Weingarden et al., 2018). Together, this line of research highlights shame and anxiety as important treatment targets in BDD and OCD, to potentially reduce adverse outcomes.
Body Image Distress in Non-Psychiatric Medical Populations:
Since arriving at Massachusetts General Hospital, I have extended my work on risk factors for body image distress beyond psychiatric patients, to also understand risk and resilience for body image distress in medical patients who may be facing changes to physical appearance. As a postdoc, I earned two fellowship awards from the President and Fellows of Harvard College, to prospectively study risk and protective factors for body image distress in women undergoing mastectomy with breast reconstruction. This project is being conducted in collaboration with the MGH Division for Plastic and Reconstructive Surgery.