Wellness and Recovery After Psychosis (WRAP) Research Programs

The Wellness and Recovery After Psychosis (WRAP) Program’s team is comprised of psychiatrists, nurse practitioners, social workers, and researchers who are all dedicated to helping our patients lead meaningful, productive lives. We utilize evidence-based, coordinated specialty care through the NAVIGATE modelAt the WRAP Program, some of the services we provide include medication management, therapy, and meeting with peer specialists. Boston Medical Center and the WRAP team is committed to serving vulnerable populations by providing accessible integrated care to all patients in our community.

Our evidence-based clinical care also informs our research priorities; the research we do is conducted with the goal of improving care for our patients. As such, we are currently engaged in collaborative and integrative research focused on evaluating both novel and existing models of care.

To learn more about all of the clinical services we offer, please visit our BMC page: https://www.bmc.org/wellness-and-recovery-after-psychosis-wrap


Director:

Dr. Hannah Brown

Dr. Hannah Brown is an adult psychiatrist at Boston Medical Center and is the Director of the Wellness and Recovery After Psychosis (WRAP) program. She earned her MD from Harvard Medical School, completed residency training in adult psychiatry, and completed a fellowship in schizophrenia at Massachusetts General Hospital. She is a recipient of a 2013 NARSAD Young Investigator Grant and the American Psychological Association Early Academic Career Award on Schizophrenia Research, as well as a 2014 Dupont-Warren Fellowship awarded through Harvard Department of Psychiatry. She currently treats patients with psychosis and has both clinical and research interests in first episode care. In her spare time, she enjoys spending time with her family and running; she hopes to eventually train for a marathon again.


Current Research Projects:

Early Episode Psychosis Repository for Coordinated Health Care Services and Medical Prevention

The Early Episode Psychosis Repository is an ongoing compilation of data concerning people experiencing their first episode of psychosis and service use. By collecting this data, we aim to better understand the needs of the people we serve, as well as how our comprehensive care model can better help meet those needs.

Laboratory for Early Psychosis Research (LEAP Center)

The LEAP Center at McLean Hospital is dedicated to researching patient outcomes and treatment impacts in the first episode population. In order to do so, the center is conducting a multi-site study collaborating with many specialty clinics in the area, including the WRAP program. Other collaborating programs include McLean OnTrack, Massachusetts General Hospital First-Episode and Early Psychosis Program, Massachusetts Mental Health Clinic Prevention and Recovery from Early Psychosis (MMHC PREP), Cambridge Health Alliance Recovery in Shared Experience (RISE), and Prevention in Early Psychosis West (PREP West).

Each of the participating sites contributes data in order to contribute to a more comprehensive view of health outcomes in the first episode patient population. With growing evidence that early intervention in the course of schizophrenia leads to greatly reduced chronicity, disability, and relapse, information on, and resources for, the implementation of early intervention programs is of monumental importance. The Massachusetts Psychosis Network for Early Treatment (MAPNET), together with the LEAP Center, aims to address this need through this multi-site collaboration.

Digital Opportunities for Outcomes in Recovery Services (DOORS): A Digital Literacy Skills Program

The DOORS program is a collaborative effort led by the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center and co-investigator Dr. John Torous involving a 6 week intervention designed to teach digital wellness skills to patients with a serious mental illness.

This study addresses the importance of technology as a medium for resource accessibility in patients experiencing severe mental illnesses. DOORS utilizes a hands-on and interactive training program grounded in self-determination theory, technology use cases, and interpersonal therapeutic alliances. This study aims to lessen the digital divide by fostering skills and knowledge necessary to utilize technology to improve one’s mental health.

Mental Contrasting with Implementation Intentions (MCII) as a Stand-Alone Intervention to Increase Exercise in People with Mental Health Challenges

In collaboration with Julie Browne, Ph.D, our co-investigator from Massachusetts General Hospital, we aim to investigate whether the MCII intervention can help patients with a serious mental illness exercise more. We would also like to investigate its effect on exercise motivation, exercise self-efficacy, goal difficulty and confidence, quality of life, and depressive symptoms. MCII stands for Mental Contrasting with Implementation Intentions. This intervention involves goal setting and planning through discussion with study staff as well as the completion of handouts and forms.

At the end of the visit, participants schedule two follow up visits to examine the short-term and long-term effects of MCII. The first visit is scheduled for a week later, while the second will be scheduled for two months later. These are the only times we ask participants to come in for the study. At these visits, we present several questionnaires about exercise and health as well as personal experiences with the MCII intervention. Research staff can assist participants in completing these questionnaires.

We are interested in increasing exercise in this population because premature mortality from preventable and treatable medical condition is a major health issue. Exercise is a valuable solution, one that leads to both physical and mental health improvements for people with serious mental illnesses. This is a novel approach that aims to address barriers such as feasibility and motivation.

Monitoring, prevalence, and treatment of hypertriglyceridemia in individuals with primary psychotic disorders taking anti-psychotic medication

Individuals with severe mental illness have a shortened life expectancy compared to the general population due to a number of factors including psychotropic medication. Though medication is a necessary component of treatment for individuals with primary psychotic disorder, it is frequently associated with undesired side effects such as weight gain and obesity. Obesity is associated with metabolic syndrome, a cluster of conditions resulting in an increased risk of developing type 2 diabetes, stroke and cardiovascular disease.

Elevated serum triglyceride levels, associated with metabolic syndrome, are an independent risk factor for cardiovascular disease and individuals taking antipsychotics are found to have higher triglyceride levels than the general public. Despite existing literature suggesting reduction of triglyceride levels is associated with reduction of mortality risk, most patients do not receive adequate testing. Omega-3 supplementation has also been shown to be well-tolerated and possibly the safest lipid-altering agent currently available. We are interested in triglyceride levels in individuals taking antipsychotic medication, frequency of monitoring, and treatment with Omega-3 supplementation.

The purpose of this study is to examine monitoring and intervention practices within the Wellness and Recovery After Psychosis Clinic to improve the health outcomes of patients with a primary psychotic disorder.

Virtual Group Fitness and Nutrition Intervention for Individuals with Psychosis

Patients with Schizophrenia-Spectrum Disorders (SSD) are subject to a higher rate of mortality than the general population, often as a result of antipsychotic medications and their subsequent effects on cardiovascular health. While treatment-emergent cardiac effects play a role in the holistic health of a patient with SSD, evidence suggests that lifestyle factors also play a significant part in the morbidity and mortality of this population.

Sedentary lifestyle and unhealthy dietary habits have been identified as modifiable determinants of cardiometabolic health in patients with SSD. This study aims to investigate the feasibility of virtual nutritional and fitness interventions for remote participant engagement. Weekly group fitness and interactive nutritional information sessions are designed to positively change the dietary and exercise habits of patents with SSD.

This study is unique in its implementation of virtual outpatient services, examining the accessibility of this population and their acceptance of a new medium for therapeutic resources. This study will collect patent reviews of the virtual services, weekly attendance, and data pertinent to the cardiovascular health of its participants to assess the effectiveness of these interventions.

Project SUCCESS: Effectiveness of Cognitive Enhancement Therapy versus Social Skills Training in Serious Mental Illness

Psychosocial treatments are beneficial interventions for behavioral health patients that improve community and social functioning. This study (funded by the Patient-Centered Outcomes Research Institute) explores the effectiveness of two forms of psychosocial therapies for Schizophrenia-Spectrum Disorder (SSD) patients: Cognitive Enhancement Therapy (CET), and Helping Ourselves Pursue and Experience Success (HOPES).

19 mental health service sites across New England administer either CET or HOPES and report the measurable functioning of their participants following 12 months of group and individual therapy interventions. Primary outcomes of these interventions are measured as community functioning, while secondary outcomes are measured as neuro-social cognitions.

This study aims to compare functional outcomes of patents between two methods of therapy. The goal is to resolve a clinician’s decisional dilemma between treatment plans for the best potential outcome of their patient.