Rappaport

Not only is the mystery of the brain itself still an enigma on a universal scale, but the very nature of psychiatric diagnoses relies heavily on subjective, patient-to-doctor reporting that is prone to all the whims of human nature.

So when it comes time to study and treat mental disorders, scientific accuracy is not always a given.

Dr. Javaras, an assistant psychologist at McLean Hospital, an assistant professor at Harvard Medical School and the recipient of Rappaport Mental Health Research Scholar Awards in 2015-16 and 2016-17, has been trying to bridge that gap. Because, as she succinctly says, “If you can’t measure it, you can’t study it.”

She brought a mind built to, and bent on, improving psychiatric measurability when she arrived at McLean in 2015. Her resume was impressive – a BA in Statistics from Harvard, a Rhodes Scholar and Doctor of Philosophy in Statistics from Oxford, and a Ph.D. in Clinical Psychology from the University of Wisconsin at Madison – but perhaps more importantly, she came with a first-hand understanding of the devastating effects of mental illness.

As a young ice skater, she had helplessly watched a teenage friend who developed anorexia nervosa (“the most inept I’ve ever felt in terms of how to help someone”), and later she witnessed the impact of severe mental illness on a graduate school colleague.

At McLean, her research and clinical practice would be to specialize in eating disorders and other eating-related challenges, and she understood that to best help those like her young friend so many years before, and others, she would need to first get the best information possible.

So in order to study eating disorders, she would have to be able to most accurately measure eating behavior. With the help of the Rappaport Award, she spent two years learning how best to do it.

“It’s hard in general to see your eating objectively,” Dr. Javaras said. “When you have an eating disorder, your perspective may become even more skewed in terms of how you’re eating.”

To test that theory, during her Rappaport-backed work she used an experimental manipulation commonly used in social psychology to study (mild) social ostracism. She looked at whether participants ate more or less of highly tasty snack after they had been socially ostracized, compared to how much they ate when they hadn’t been socially ostracized.

The Rappaport award funded the development and initial piloting of the task in the first year, and for that she earned a competitive renewal of the prize which paid for its implementation in a sample with a diverse range of eating behavior, including binge eating, in the second year.

The results? As Dr. Javaras and others had hypothesized, people’s reports of their eating when distressed, “really didn’t map up at all to what actually happened in the laboratory,” she said. “What happened when they were ostracized, it was virtually uncorrelated with what they tended to happen to their eating in that type of circumstance.”

Again to the premise: If you can’t measure it, you can’t study it. Her ideas now backed now by the results from her early laboratory work, Dr. Javaras has since that time been focused on using objective approaches to measure eating behavior, both in the laboratory and out of it.

After all, she said, “The end game is to try and get a better measure that actually is more related to what people do in the real world.”

As part of those efforts, she plans to pilot the use of cutting-edge, wearable cameras that collect repeated, objective measurements as individuals go about their day-to-day lives.

The second step in this line of research is using functional brain imaging to understand how individuals with eating disorders make decisions. It’s an understanding that is crucial for developing treatments that help people with eating disorders make everyday choices that promote recovery.

“I’m doing a study of what’s happening in the brain when people are making food-related decisions,” she said, “and that could suggest new, more targeted interventions, depending on what areas of the brain are involved.”

In her own clinical practice, those interventions would mean therapy interventions aimed at promoting more adaptive behaviors and thoughts, but the discovery of more targeted pharmacological

When she considers the impact of the Rappaport award, and subsequent competitive renewal of that grant, Dr. Javaras recognizes what an agent of catalyzation it was during that critical period of her McLean career. Not only was it vital in terms of setting up her program of research, but it also gave her the time and funding to establish practices, procedures and infrastructure that she has continued to use while furthering her investigation since.

It also, of course, provided foundational knowledge upon which she has built subsequent research, and significantly, that data has been used in the process of earning subsequent federal funding.

“The Rappaport Award was really crucial in that early stage of my career,” she said. “First of all, you’re at the beginning of developing a program of research, and it was enormously helpful in supporting the collection of initial data. It can allow you to do slightly riskier research, too, because there is a little more flexibility. It can allow you to sort of try out some ideas you might have that are more in the initial phases.”

Dr. Javaras becomes somewhat philosophical when she considers the “why” of her work.

“I always feel like each of us should contribute what we’re passionate about and good at, and the world will be better off if we do,” she said. “One place where I can make some contributions is in terms of measurement and rigor and scientific methodology.”

She is unique in her ability to use a combination of clinical, epidemiological and methodological research that draws on her expertise as both a clinical psychologist and a statistician. It’s work that crosses disciplines, which reminds one of the Rappaport Foundation itself, and its broader mission of elevating innovative work in not only medicine, but in the arts and public policy as well.

“They have really admirable goals, in terms of what they’re striving to do,” she said. “I aspire to do research in keeping with their mission, and I greatly appreciate the Rappaports because they gave me a chance to blend my passion for methodology with a project that yielded insight that can actually help people.”