Juna Khang ’20

McLean Hospital, Center for Depression, Anxiety, and Stress Research, Belmont, MA

When people ask me, “Where did you work this summer?” I always pause and consider what I should say. Most of the time I would say that I worked at McLean Hospital, which led to some people thinking it was just a general medical surgical hospital. Other times, those familiar with McLean as Harvard Medical School’s psychiatric affiliate would think that I worked directly to provide clinical care to patients with affective and psychotic disorders, especially if they were familiar with the number of famous people who have been treated there. As much as I would like to time-travel 50 years in the past as an officially trained mental health professional getting the chance to do a clinical interview with Sylvia Plath and making my mark on The Bell Jar, being a part of research this summer in the world’s largest neuroscientific and psychiatric research program in a private hospital was such an incredible learning experience.

Receiving home-use transcranial direct current stimulation as part of the instructional video for participants

On the topic of time-travel, if I went back and told myself in sophomore year that I would be working in PI Diego Pizzagalli’s Center for Depression, Anxiety, and Stress Research, I don’t even know what I would say. Dr. Pizzagalli is known for his work determining valence systems constructs in NIH’s Research Domain Criteria (RDoC), an integrative research framework for mental illness whose goal is to answer the problems with the DSM-5’s categorical approach to diagnosis, as well as his depression research that utilizes biomarkers and neuroimaging techniques. I became familiar with his work through my class and research with Professor Dan Norton—I remember doing literature reviews of Dr. Pizzagalli’s work to create a similar eligibility criteria for our study. In fact, I am sure that much of my appreciation for the opportunity this summer is due to my familiarity with the neuroimaging techniques and the field of clinical psychology research of affective disorders from my classes and research at Williams.

The project in which I participated was called BRAINSTIM: we were investigating the treatment response to non-invasive brain stimulation of transcranial direct current stimulation (tDCS) in anxious depression, using fMRI, behavioral tests, and clinical evaluations. In particular, we were investigating the effectiveness of home-use tDCS as a treatment. tDCS uses weak electrical currents applied bilaterally to the dorsolateral prefrontal cortex (DLPFC) to stimulate the brain. The practice of using direct current to treat neurological disorders has been around for over a century but lost prominence due to the development of antidepressant drugs in more recent years. However, the method is now experiencing a research revival and there is a growing body of evidence that it can be used as a treatment for disorders such as depression and anxiety. Although most people first think of antidepressant medication and/or therapy when they think of treatments for depression, a different form of brain stimulation known as repetitive transcranial magnetic stimulation (rTMS) has been an FDA-approved treatment for depression since 2008. However, TMS requires in-clinic attendance and can be quite expensive per session, especially as not all insurance companies will cover this therapy. Thus, the tDCS remote supervised home use protocol was developed with the goal of providing an alternative safe, reproducible, well-tolerated, and stimulation therapy outside of the clinic.

Analyzing fMRI data.
Analyzing fMRI data.

During my internship, I worked closely with Dr. Maria Ironside, who has extensively researched the cognitive neuroscience of anxiety and depression, brain stimulation, and brain imaging techniques. Dr. Ironside was considerate and appreciative; always taking the time to teach me new things and answer 
any questions I had. For example, she taught me all about neuroimaging and showed me how to analyze 
our fMRI data with SMP12 and CONN. In fact, the entire lab environment was friendly and collaborative: 
no matter what specific project or role one played, everyone was eager to help each other out.

I also had not realized how important coding was in clinical psychology research. Last summer I worked 
with Psychtoolbox, but I attributed that use to the particular psychophysics research on which I was working. This summer, I had the opportunity to become familiar with PsychoPy (Python), MATLAB, and Presentation. I edited scripts for our scanner task as well as behavioral tasks, in addition to helping my post-doc with data analysis in R of her collaboration with a clinical neuroscience team in São Paulo, Brazil. Working in clinical psychology research has really taught me that in addition to theory, there remains the need for a wide range of skills and knowledge.

Furthermore, I experienced firsthand the long process of IRB approval of a clinical trial involving humans, with multiple resubmissions of protocol, consent forms, and other documents needed in order to ensure ethical standards were being met. As bureaucratic and trivial as some of the reviews were, the process opened my eyes to the level of detail necessary in proposing a study, as well as the ethical progress we have made in psychology research. It has only been around 60 and 50 years, respectively, since the infamous social psychology experiments by Milgram and Zimbardo. Going from studies such as the Obedience Experiment and Stanford Prison Experiment that inflicted psychological trauma upon its unknowing participants, to the IRB requiring resubmission for a missing comma in the protocol summary, I think I can safely say that among human studies, and especially clinical trials involving affective disorders, there is little to no concern about abuse of participants.

To the Class of 1972 and the ’68 Center for Career Exploration, I am incredibly grateful for this career opportunity and learning experience that will allow me to return to my final year at Williams, and specifically my field of study, with an awareness of a multimodal approach to affective disorders as well as a wealth of knowledge on research and imaging techniques that previously I had only read about in textbooks.