Research at Riggs
The Austen Riggs Center intensive clinical program for patients with treatment resistance also provides a unique opportunity to do clinical research to learn from our work. The Erikson Institute at Riggs provides intellectual and practical support for clinical staff interested in doing such research.
Past significant Riggs research studies include the 1980’s MacArthur Foundation-funded study by Richard Ford and Sidney Blatt that quantified the benefits of long-term, intensive, psychoanalytically informed treatment through psychological testing measures. This led to the publication Therapeutic Change: An Object Relations Perspective. In the 1990’s and into the 2000’s Riggs ran the Follow Along Study (FAS) which tracked a group of 226 Riggs patients between 1993 and 2001, both while in treatment at Riggs and beyond. This created a rich and extensive archive of data for asking a range of research questions.
The Austen Riggs Center is now engaged in an ongoing process of evaluating the greater research landscape to identify opportunities for new research initiatives that we might undertake to advance our understanding and treatment of psychiatric disorders.
A number of projects are currently ongoing or are in planning at Riggs. These focus on topic areas:
- Clinical Assessment
- The Therapeutic Community
- Response to Treatment
- Real-Life Impact of Treatment
1. Clinical Assessment
Project: A History of Psychological Testing at the Austen Riggs Center
Summary: Psychological testing has long been a central part of Riggs clinical assessment. Has there been a changing dynamic in the way data is captured, or conclusions drawn? Using a specially developed questionnaire, the investigators are analyzing archival psychological testing reports from the 1940s to the present to confirm such changes and interpret their impact on diagnosis. The broader scope of this project evaluates how our models of the mind influence and mediate clinical inferences. This will be analyzed at various levels to analyze the ways in which institutional, cultural, and ideological forces shape our manner of interpreting clinical phenomena. As well as providing a historical perspective on psychological testing, this study should help better situate the contextual nature of psychological models.
Project: A Comprehensive Instrument to Assess Lifetime Bullying Experience
Investigator: Jane Tillman, PhD, ABPP, Staff Psychologist and Evelyn Stefansson Nef Director, Erikson Institute for Education and Research and Samantha Grzelak, Administrative Assistant
Summary: Project in development. Whether one has ever been bullied, or has themselves been a bully at some point in life can play into later psychosis, substance abuse and suicidality. A history of lifetime bullying experience is not currently collected at Riggs but this is of great interest. With a view to assessing this area, the investigators are evaluating existing bullying survey instruments to identify one to adequately survey lifetime bullying experience. If such an instrument cannot be identified, the investigators will develop a new instrument based on those available. It is anticipated that this project will be of interest to the broader research community.
2. The Therapeutic Community
Project: A Study of Social Dreaming at Riggs: An Analysis of Group Dynamics
External Collaborator: Mark Elliot, MD, (former Austen Riggs Center Psychiatry Fellow)
Summary: There is a history of listening to individuals’ dreams in the context of the community as a way to understand the situation of the collective group. This study examines the relationship between i) the dreams of patients at Riggs captured over a series of weekly group research sessions, and ii) the conscious ideas of members of the Riggs staff captured weekly meetings during the same time period. The hypothesis is that a relationship will be discovered between the two and that this will inform us about the nature of group dynamics.
Project: Changes in Patients’ Community Participation in Relation to Time in Treatment
Investigator: Peter Hummel, Therapeutic Community Program Staff
Summary: Project in development. Riggs patients have opportunities to participate in a variety of community activities such as community leadership, meetings, classes, and artistic exploration in painting, pottery, crafting and theatre at the Riggs’ Lavender Door. Does community participation change over time in treatment and program level? As one gains more independence, does one utilize community program offerings less, or more? The investigator will address this question through a new survey instrument developed in collaboration with the patient community.
3. Response to Treatment
Project: An Instrument to Measure Changes in Dynamic Family Function
External Collaborator: Thomas Lusignan, LICSW (former Austen Riggs Center Staff Social Worker)
Summary: The problems of “treatment resistance” are maintained within a particular human context, usually the family. An important part of the Riggs’ care continuum is family therapy, and research suggests patients do better when their families also receive treatment addressing structural or second order change, not just symptom amelioration. There is, however, no standardized tool for measuring this kind of change in families. How can family functioning be operationalized across multiple dimensions with a psychodynamic perspective? This study is developing the Dynamic Family Functioning Instrument (DFFI), a tool by which family dynamics can be “mapped,” and structural change can be recognized and measured. The DFFI is in development and will be tested against archival records before being used in the assessment of participant patients and their families at Riggs. DFFI aims to fill an unmet need among clinical ratings and may become a valuable teaching tool for structural change in family dynamics.
Project: Collection, Analysis and Utilization of Brief Symptom Inventory (BSI) Data
Investigator: Steve Ackerman, PhD, Staff Psychologist
Summary: At multiple times during treatment at Riggs, patients complete the Brief Symptom Inventory (BSI), a standard self-report psychological symptom scale. This is completed at the time of a patient’s clinical entry, at six weeks of stay (the time of the patient’s first clinical case conference), at six months of stay, thereafter every six months, and on discharge. Riggs’ aggregate BSI data from a recent 3-year period indicates that between admission and final discharge there are statistically significant improvements in BSI measures of depression, anxiety and obsessive-compulsive behavior. BSI data can potentially provide indices of patient response to treatment. This data is being collected and analyzed in an ongoing manner and additional measures may be added in the future and should inform us for treatment planning purposes.
4. Real-Life Impact of Treatment
Project: Exploration of Mood Disorder in Treatment-Resistant Patients
Summary: Dr. Weinberg is leading two studies that examine different aspects of mood. Both studies have utilized data from subsets of patients participating in the Follow-Along Study described briefly in the introduction section.
The first study set out to look at patients with a major mood disorder and comorbid diagnoses, defined as treatment resistant. The findings suggest first and foremost that clinical change is a deeply individual experience. Patients defined as treatment resistant did show improvement in treatment and importantly, a small subset group does very well at Riggs even after failing treatment in multiple other programs. A second study continues this research monitoring mood fluctuations in a group patients for many years after discharge from Riggs. Preliminary findings suggest that while mood fluctuations can continue immediately after leaving Riggs, over time these improve and stabilize. This study aims tell us something about the real-life impact of Riggs treatment on those patients deemed treatment-resistant.
Project: The Nature of Personality Change in Individuals with Severe Disturbance in Treatment
Investigator: Steve Ackerman, PhD, Staff Psychologist
Summary: This study looks at 204 patients from the Follow-Along Study for changes on the Anaclitic-Introjective (A-I) Scale of personality assessment over time. The hypothesis is that, at baseline, Anaclitic patients will have a greater preoccupation with interpersonal dependency compared to Introjective patients; and that later in time, Anaclitic patients will demonstrate a greater capacity to differentiate self from others and to understand the mental states of others. Conversely in this hypothesis, Introjective patients will at the baseline demonstrate a basic limited concern or care for others, but will later move towards greater empathy and concern for others.
Project: States of Mind in Patients Following a Near-Lethal Suicide Attempt
Investigators: Jane Tillman, PhD, ABPP, Staff Psychologist and Evelyn Stefansson Nef Director of the Erikson Institute for Education and Research; Jennifer Stevens, PhD, Staff Psychologist; Kim Hunter-Schaedle, PhD, Mgr. of Institutional Research
External Collaborator: Jill Clemence, PhD; Katie Lewis, PhD, Albany Medical College
Summary: The focus of this research is to endeavor to understand the near-lethal suicide attempt, a complex topic that has not been well studied. The original States of Mind Study (SOM I) enrolled 131 persons in treatment at Riggs between 2009 and 2012. 71 had made a suicide attempt prior to admission; 60 had no history of suicide. All completed surveys on suicidality and topics such as self-destructive behavior. A subset of 11 participants had survived a near-lethal suicide attempt and were interviewed about the events leading to the attempt. The transcribed text of interviews has been analyzed using a mixed methods approach (qualitative and quantitative analysis) to understand state of mind immediately prior to a suicide attempt. Now in a second phase (SOM II) the investigators are looking further at the medical records of the 131 participants in SOMI and at medical records for those 174 patients who were in treatment at Riggs during the SOMI recruitment period but did not participate in SOMI. This aims to define mortality rates for this larger group of patients and to seek identifying factors such as life traumas in relation to the context of suicidality. This study may identify hallmarks to better understand the suicide attempt.
Project: Testing an Object Relations Theory of Suicide
Investigator: Lee Damsky, PhD, Staff Psychologist
External Collaborators: George Bombel, PhD; Shweta Sharma, PsyD, Menninger Clinic, Houston, TX
Summary: In the object relations theory of suicide, the suicidal self-attack is driven by rage toward an overwhelming introject that is also a part of the self. This study will assess whether suicidal/self-injurious behavior in psychiatric patients is associated with evidence of an “overwhelming other” in psychological testing, as measured by the Mutuality of Autonomy (MOA) scale of the Rorschach Test. Pathological scores on the MOA assess if and how a patient’s Rorschach responses depict objects that are controlled, harmed or obliterated by another object or force. MOA scores will be compared across four groups of patients, ranging from those with no self-injurious or suicidal behavior to those who have completed suicide. It is hypothesized that MOA pathological scores will correlate with the degree of lethality of self-harm behavior.
Project: A Prospective Study of Affective States in Suicide-Related Outcomes
External Collaborators: J. Christopher Fowler, PhD, Menninger Clinic, Houston, TX; Herbert Hendin, MD; Blake Turner, PhD
Summary: This study assesses emotional risk factors for self-destructive behavior, including suicide attempts in 150 Riggs patients. It is based on data from the Affective States Questionnaire, a measure of intense affective states. Patients are interviewed at baseline and in follow-up interviews at three-month intervals for 12 months. This study may help better understand the experience of intense affects over time, their effects on functioning and their link to self-harm.
Project: Reclaiming a Life: Exploring the Relationship between Birth Stories, Life Purpose Fantasies, and Suicide
Summary: This study investigates potential links between a person’s risk of self-harm and suicide, and their beliefs about their birth circumstances, including any fantasies thy have about their parents’ birth purpose. The overarching hypothesis is that in seriously disturbed patients, these factors are indeed linked. To explore this, a Family of Origin Questionnaire was conducted in collaboration with the States of Mind I study (described above). This Questionnaire asked 131 patients in treatment at Riggs between 2009 and 2012 about their circumstances of birth e.g. were they planned/unplanned; was there trauma at time of birth for themselves or their mother; were there familial stressors proximal to their birth (deaths in the family, divorce, financial stress, etc.), were they adopted, etc. This also asked and whether there was a fantasy of life purpose (why was I conceived?) and a fantasy about whether this purpose had been fulfilled. This data is being coded to identify statistically significant links between birth story variables and suicide status particularly for individuals who fall on the most positive and negative ends of the spectrum. This work could shed further understanding on published research in this field linking birth events to later life ‘ownership’, and to suicidal ideation as a means of self-redefinition or even reclamation of the body.
To provide support for busy clinicians to conduct research, the Erikson Institute Research Department encourages research project discussions through a series of ‘lab meetings’ where research ideas can be discussed and results presented; has an Institutional Review Board chaired by Elizabeth Weinberg, MD, to ensure protection of human subjects; and helps investigators to develop their research proposals and seek research funding.
Riggs also has a roster of expert outside research consultants as listed below and is engaged in an ongoing process of consultations with members of this group to develop and refine both established and emerging research projects.
Linda Mayes, MD, Interim Director of the Yale Child Study Center and Special Advisor to the Dean of Yale School of Medicine is Chair of our Research Consultation Group and a Senior Consultant to the research program.
David Reiss, MD, former Erikson Scholar and currently on the staff of the Yale Child Study Center is a Senior Consultant to the research program.
Erikson Institute Research Consultation Group:
Linda Mayes, MD, Yale Child Study Center (Chair)
Jacques Barber, PhD, Adelphi University
John Clarkin, PhD, Cornell Weill Medical Center
Patrick Luyten, PhD, University of Leuven, Belgium
Kevin Meehan, PhD, Long Island University
Nancy Suchman, PhD, Yale Child Study Center
Mary Target, PhD, University College London
Robert Waldinger, MD, Massachusetts General Hospital