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C. Barr Taylor, M.D.

C. Barr Taylor
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Projects

Using Technology to Improve the Treatment of Eating Disorders

Eating Disorders (EDS) are important problems affecting an estimated 13.5% and 3.6% of US college-age women and men respectively. Yet less than 20% of students report receiving treatment. The purpose of this NIMH funded study is to determine if a coached, app based eating disorder intervention can reduce symptoms in students with eating disorder. Participants are being recruited from 28 colleges and universities, with half being randomized to a prevention program/and/or referral and the other half being randomized to the intervention. 650 students with EDs will be recruited and followed for up to two years when the study ends in the Spring of 2018. Dr. Taylor and his research team are conducting a number of studies related to prevention and treating eating disoders.

Of relevance to global mental health, we partner with the European Commons eCare project to develop and evaluate programs that can be disseminated internationally. The eCare project, directed by Dr. Corinna Jacobi, PhD, involves a consortium of investigators throughout Europe, and Dr. Taylor is one of the senior advisors.

Dr. Taylor is also working alongside Dr. Josef Ruzek and Dr. Joseph Bankman as the Director of the Center for m²Health. The primary purposes of the Center are to develop, evaluate, and disseminate new ways to use technology and to help provide affordable, accessible, evidence-based mental health care to large, defined populations. Please visit the website at www.m2health.paloaltou.edu to view ongoing projects, active collaborations, publications, various resources, and to meet the team.

The e:Courage Project

There are presently many millions of trauma survivors scattered across the globe, large numbers of whom suffer from PTSD (post-traumatic stress disorder) and/or other stress-related problems. While there is a great need for mental health care and assistance among the global population of trauma survivors, services are largely not available nor are they likely to become available in the short term, due to a lack of resources and mental health care infrastructure. In this environment, development and implementation of technology tools that enable self-management of traumatic stress difficulties and empower local indigenous helpers to better serve their community members represents a feasible, potentially effective, and scalable strategy for reaching millions of individuals and strengthening their capacities for self- and other-care.

The e:Courage app is intended to reduce suffering and promote resilience for survivors of disaster, war, violence, sexual abuse, and other trauma. It will be designed to strengthen trauma survivor self-care and increase helper effectiveness to support individuals and communities affected by traumas around the world, especially those with limited access to mental health services. The app will offer service direct to trauma survivors, helping them more effectively self-manage their post-trauma problems; enable widespread utilization of a potentially effective technology-based helping tool by indigenous coaches, paraprofessionals, and social networks, thereby greatly increasing the range of possible care providers; and provide assistance to traumatized populations that are underserved, especially in regions of the world where mental health care access is limited or unavailable.

Staying Fit/Student Bodies Classic/Student Bodies-Eating Disorders

Over the years we have developed a “suite” of online programs to prevent eating disorders, improve body image, and promote healthy weight maintenance implemented in various settings including middle schools, high schools, colleges and universities, communities/YMCAs. More recently, these programs have been used to provide treatment and prevention tools for eating disorders. A Chinese version of StayingFit for middle school students is currently being evaluated in Hong Kong and Shanghai.

Online Anxiety Self-Help Group Study

There are numerous online interventions and self-help groups available to those looking for mental health help. Most evidence-based psychological interventions, especially those for anxiety, have been shown to reduce symptoms. However, drop-out rates tend to be very high in these community-recruited studies, and there have been very few, if any, studies analyzing the effects of self-help groups on anxiety symptom reduction.

In the past few months, we have drafted a study to determine if an online anxiety self-help group reduces anxiety, worry, and avoidance in individuals and in the group altogether. The group will be moderated by a non-clinician, and they will be given access to a number of resources, tools, and articles. Over the span of three months, the group will learn set skills and participate in various intervention strategies as individuals and as a community. We hope that providing more structure compared to most unguided self-help groups will decrease anxiety symptoms both short-term and long-term.

Project Mana Maali

Under the direction of Nitya Kanuri, we are now in our second year of project Mana Maali, which provides affordable, accessible, evidence-based coaching for anxiety disorders to students at 4 universities in India. Our dream is to have project champions in India, platform development through Bits-Pilani, and an active collaboration among the m²Health Institute, VA PTSD Training/Dissemination/App development, and Penn State.

We started this project 2 years ago to address a need -- many students in universities in India are either not getting or not accessing mental healthcare services. In some places, sufficient mental health care resources are not available (e.g., not enough counselors on campus). In most all places, stigma around mental health often prevents many from seeking help when it is available. We've proposed using an online survey to identify those with high levels of anxiety and connect them to a private, online program (supported by our amazing technology partner Lantern) and an online Indian counselor with whom they could connect via messaging or phone to learn new techniques to manage anxiety and get support in practicing them.

In doing this work over the last 3 semesters with our partner university BITS Pilani, we've learned that in addition to providing students with more (and private) ways to ask for help, an important component of addressing mental health is also attempting to reduce the stigma around it (and, in turn, increase help-seeking).

To do this, we've partnered with White Swan Foundation, an NGO based out of the National Institute for Mental Health and Neuro Sciences (NIMHANS) in Bangalore. White Swan Foundation has created a "knowledge repository" -- translated into several languages -- to address mental health stigma from the angle of awareness, education, and knowledge for the person in need of support, the caregiver, and the general community. They have been graciously supporting us for the last year with educational content to provide to students. You can learn more about them here: whiteswanfoundation.org

YMCA

Over the past three years we have been running a version of StayingFit in various sites in the San Francisco YMCAs. Our first effort was to provide a class in StayingFit at the BayView Hunter’s Point YMCA’s Center for Academic Re-entry and Empowerment (CARE). PsyD students led the sessions with students who were learning skills to help them re-enter and succeed in school. Under leadership from Katie Taylor Lynch, (a current PsyD student), we expanded the program to five more YMCAs with different student populations. This year, we partnered with the Mayor’s Youth Employment and Education Program (MYEEP) and distributed StayingFit to high school students at the Buchanan YMCA in San Francisco. In addition to completing the StayingFit program, this group of students learned skills to teach this material to others in the hopes that this program could become more self-sustaining. We hope to continue this effort through our collaboration with the San Francisco YMCAs and MYEEP in the coming years.

 

Major Active Collaborations  

Institute for International Internet Interventions for Health (i4Health) at PAU,  Ricardo Munoz, PhD, Director. 

Penn State. Major collaborator: Michelle Newman, PhD, Professor of Psychology.  Focus: anxiety disorders, big data, college/university interventions.

University of MelbourneCentre for Health Equity in the Melbourne School of Population and Global Health. Major collaborators: Brian Oldenburg, Director; Adrienne O’Neil, Assistant Professor. Our collaboration focuses on population-based, technology driven cardiovascular risk reduction. Dr. Taylor is a Co-Pi, and has been/is a collaborator on many of their grants.

Dresden University of Technology/iCare. Major Collaborator: Corinna Jacobi, PhD, Professor. Dr. Jacobi is the Principal Investigator of iCare, a large, long-term, multinational study funded by the European Commons to examine the effectiveness of internet-based affordable, accessible, evidence-based care for a number of mental health problems. Dr. Taylor is the Senior Scientific Advisor. 

Washington University, St. Louis, Missouri. Denise Wilfley, PhD, is a long-time collaborator and is Co-PI on the Using Technology to Improve the Treatment of Eating Disorders grant. 

Stanford University. Various investigators, including Joe Bankman, JD, PsyD, Professor of Law and Business and Mickey Trockel, M.D., PhD, who is developing anxiety reduction/stress management programs for law schools.

Dissemination and Training Division, National Center for PTSD, VA Palo Alto Health Care System. Josef Ruzek, PhD, Director; Erik Kuhn, PhD, in charge of app development. Dr. Ruzek is also Co-Director of the m²Health Institute.

Deakin University, Melbourne, AustraliaMajor collaborator: Joanne Williams, PhD. Dr. Williams recently completed a large study evaluating StayingFit-Weight Loss program. As Co-PI, we are assisting with writing up results of the study.

Selected Publications: 

Taylor CB, Kass A, Trockel ME, et al, Reducing Eating Disorder Onset in a Very High Risk Sample with Significant Comorbid Depression: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology 2016, 2016 May;84(5):402-14.

O’Neil A, Fisher AJ, Kibbey K, Jacka FN, Kotowicz A, Williams LJ, Stuart AL, Berk M, Lewandowski PA, Taylor CB, Paco CA, Depression is a risk factor for incident coronary heart disease in women: an 18-year longitudinal study. Journal of Affective Disorders, in press.

Cohen JM, Blasey C, Taylor CB, Weiss BJ, Newman MG, Anxiety and related disorders and concealment in sexual minority young adults, Behavior Therapy, 2016, 47, 91-101.

Purvis C, Jones M, Bailey JO, Bailenson J, Taylor CB.Developing a novel measure of body satisfaction using virtual reality. PLoS One. 2015 Oct 15;10(10):e0140158. doi: 10.1371/journal.pone.0140158. eCollection 2015.PMID:26469860

Walser RD, Garvert DW, Karlin BE, Trockel M, Ryu DM, Taylor CB. Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans. (http://www.ncbi.nlm.nih.gov/pubmed/26378720) Behaviour Research and Therapy, 2015 Aug 31;74:25-31. doi: 10.1016/j.brat.2015.08.012. [Epub ahead of print]PMID 26378720

Kanuri N, Taylor CB, Cohen JM, Newman ME. Classification models for subthreshold generalized anxiety disorder in a college population: Implications for prevention. Journal of Anxiety Disorders. 2015 Jun 17;34:43-52. doi:10.1016/j.janxdis.2015.05.011. PMID: 26119139

Oldenburg B, Taylor CB, O’Neil A, Cocker F, Cameron L. Using new technologies to improve the prevention and management of chronic conditions in populations, Annual Review of Publich Health, 2015 Mar 18;36:483-505. doi: 10.1146/annurev-publhealth-031914-122848. Epub 2015 Jan 12. PMID: 25581147

Kass AE, Trockel M Safer DL, Sinton MM, Cunning D, Rizk MT, Genkin BH, Weisman HL, Bailey JO, Jacobi C,Wilfley DE, Taylor CB. Internet-based preventive intervention for reducing eating disorder risk: A randomized controlled trial comparing guided with unguided self-help. Behaviour Research and Therapy, 2014 Oct 2;63C:90-98. doi: 10.1016/j.brat.2014.09.010. [Epub ahead of print] PMID: 25461783

Jones M, Kass AE, Trockel M, Glass AI,Wilfley DE,Taylor CB. A Population-wide screening and tailored intervention platform for eating disorders on college campuses: The Healthy Body Image Program. Journal of American College Health, 2014 Jul;62(5):351-6. doi: 10.1080/07448481.2014.901330.

Trockel M, Karlin BE, Taylor CB, Manber R: Cognitive Behavioral Therapy for insomnia with Veterans: Evaluation of effectiveness and correlates of treatment outcomes. Behavior Research and Therapy, 2014 Feb;53:41-6. doi: 10.1016/j.brat.2013.11.006. Epub 2013 Dec 15.PMID:24412462

Walser RR, Karlin BE, Trockel M, Mazina B, Barr Taylor C, Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: Therapist and patient outcomes, Behavior Research and Therapy, 2013 Sep;51(9):555-63. doi: 10.1016/j.brat.2013.05.009. Epub 2013 Jun 3.PMID:23851161

Karlin BE, Trockel M, Brown GK, Gordienko M, Yesavage J, Taylor CB.Comparison of the effectiveness of cognitive behavioral therapy for depression among older versus younger Veterans: Results of a national evaluation, Journal of Gerontology: Psychological Sciences, J Gerontol B Psychol Sci Soc Sci. 2015 Jan;70(1):3-12. doi: 10.1093/geronb/gbt096. Epub 2013 Nov 10 PMID:24218096

Wilfley D, Agras WS, Taylor CB. Reducing the Burden of Eating Disorders: A Model for population-based prevention and treatment for university and college campuses. International Journal of Eating Disorders, 2013, 46, 529-532.

Newman MG, Przeworski. AJ, Consoli AJ, Taylor CB. A randomized controlled trial of ecological momentary intervention plus group therapy for generalized anxiety disorder. Psychotherapy: Theory, Research, Practice, Training, 2014 Jun;51(2):198-206. doi: 10.1037/a0032519. Epub 2013 Sep 23.PMID:24059730

Ohlmer R, Jacobi C,Taylor CB. Preventing symptom progression in women at risk of anorexia: A pilot study. European Journal of Eating Disorders, 2013 Mar 21, 4, 323-329. doi: 10.1002/erv.2225. [Epub ahead of print]PMID: 2352015210.1080/21662630.2013.794521

 
 
 

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