Mount Sinai Announces Center for Stress, Resilience and Personal Growth [newswise.com]

Newswise — (New York, NY – April 30, 2020)  -- Mount Sinai Health System (MSHS), one of New York’s largest integrated health systems, announced today the launch of the Mount Sinai Center for Stress, Resilience and Personal Growth, a first-of-its-kind initiative in North America that is designed to address the psychosocial impact of COVID-19 on the mental health and lives of frontline health care providers at Mount Sinai and will serve as a model for institutions and communities around the globe. Deborah B. Marin, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai (ISMMS) and Director of the Center for Spirituality and Health at Mount Sinai, will direct the newly established Center.

“Mount Sinai’s doctors, nurses, trainees, students, and clinicians and support staff are on the front lines of the battle against COVID-19, healing as many people as possible, yet they are witnessing death on a scale no one should ever have to endure,” said Dennis S. Charney, MD, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and President for Academic Affairs for the Mount Sinai Health System. “Many are absorbing the anguish of patients’ final hours, serving as a lifeline for patients and families who are unable to be at the bedside, while facing personal danger and the ever-present risk of becoming infected themselves to the virus.”

“As a result, our health care providers are working at an intensity level so stressful that tens of thousands will likely suffer post-traumatic stress disorder in the wake of the pandemic. Their brave service in the face of this unprecedented challenge is a debt we must repay through generous mental health support services. Our goal through the Center is to understand and treat the profound anxiety and grief our heroic health care professionals are experiencing and will continue to face. We must help them recover to ensure the future of our health care system.”

“This multi-disciplinary center will consider the physical, emotional, mental and spiritual needs of our entire health care community, including those on the frontline and in supporting roles,” said Dr. Marin. “Working closely with every department across the health system, our aim is to not only address  but to also prevent the development of mental health issues before they occur by intervening early, offering resilience training and treatment for every health care working in need. It’s important that we launch now as this crisis continues to evolve and take a toll on our community.”

Resilience Training

Drawing on MSHS’s extensive expertise in post-disaster intervention and resilience training, which includes 9/11 first responder monitoring and treatment services delivered through the World Trade Center Health Program’s Clinical Center of Excellence at Mount Sinai, the program initially will focus on building resilience in our frontline providers across the eight hospitals and clinical sites that comprise MSHS.

Key components of the Mount Sinai Center for Stress, Resilience and Personal Growth:

Screening: Every frontline health worker at MSHS will receive a personal invitation to be screened for for stress and mental health self-screening. Screening will include an assessment of occupational exposure to COVID-19, prior history of stress and mental health conditions, new personal and family stressors arising since the pandemic onset, and current presenting problems including increased use of alcohol or drugs. The outcome of the screening will be complemented by data from an employee-wide baseline survey conducted by Mount Sinai’s Office of Well-Being and Resilience on exposure, mental health, and risk and protective factors.

Interventions: The Center will offer a range of interventions, including:

• Workshops/open groups: trained staff will lead these sessions, using best practices and training principles developed at Mount Sinai, to foster resilience among health workers. Six primary resilience domains will be emphasized to help each health care worker establish important personal wellness goals: career, physical, emotional, social, family, and spiritual. These sessions will be supplemented by a new website that will further empower health workers to engage in recovery and wellness.
• Eight-session support groups: social workers and other trained staff will lead these groups, providing health workers with a more dedicated experience that enables them to process and grow from their significant COVID-19 exposures. Combining established approaches with creative adaptations, participants will process their experiences, reflect on how those experiences impact their personal lives, and engage in resilience-enhancing strategies such as reframing and harnessing social support to help them heal.
• Individual assessments: health workers will also have the option to meet individually with a Mount Sinai social worker care coordinator to develop an individualized resilience plan that addresses key wellness domains in their life.
• Mental health treatment: health workers who develop a COVID-19-related mental health condition, such as PTSD, depression and/or alcohol use disorder, or whose pre-existing mental health conditions worsen as a result of COVID-19, will also be referred to clinical providers with expertise in treating trauma-related conditions both within and beyond MSHS.

Research: Drawing on the resources of the Icahn School of Medicine at Mount Sinai, one of the leading institutions in the field of post-traumatic stress research, the program will collect data and offer all participants opportunities to enroll in studies designed to better understand the unique mental health care needs arising from exposure to the COVID-19 pandemic. Researchers will also examine longitudinal data to investigate changes among participants over time and assess the efficacy of the program’s resilience-enhancing interventions by comparing pre- and post-intervention data. Proposed studies include:

• Identification of Psychosocial and Biological Determinants of Risk and Resilience: Researchers will conduct a longitudinal study of psychosocial factors associated with risk of and resilience to COVID-19 stress among both Mount Sinai’s frontline health workers and in the New York City community more broadly. Participants will complete a series of detailed, longitudinal surveys collecting information regarding exposure to COVID-19-related stress, medical and psychiatric history, psychosocial and lifestyle factors, coping styles, and symptom questions focusing on anxiety, depression, and post-traumatic stress symptoms at four distinct assessment times. Blood samples will also be collected from a subset of study participants to examine peripheral biomarkers (e.g., genomic, inflammatory) of risk and resilience to COVID-19-related stress. The goal is to generate knowledge that will inform preparedness for future pandemics, natural disasters, or other forms of extreme stress, and knowledge about underlying mechanisms of risk and resilience.
• Longitudinal Study of COVID-19-related Memories: Building on seminal research on ‘memory reconsolidation,’ or the flexibility of emotional memories, by Mount Sinai faculty, researchers will conduct a pilot longitudinal study to examine how COVID-19-related memories change over time, including a pilot neuroimaging component to understand the neural mechanisms underlying emotional control and flexibility. Comparing emotional processing in the brain of resilient COVID-19-exposed individuals and COVID-19-exposed individuals who developed PTSD creates the potential for the development of innovative treatment approaches for individuals with trauma-related mental health conditions.
• High Resolution Neuroimaging of the Threat Response System in Individuals Exposed to COVID-19: Using a Mount Sinai-developed ultra-high field 7-Tesla (7T) MRI platform for imaging the structure and function of the locus coeruleus (LC) – a structure that is critically implicated in the human response to threat and stress – researchers will examine the LC threat system among individuals who have experienced COVID-19-related stress to characterize the biological responses that are associated with the development of PTSD versus resilience to stress. This work will provide an essential understanding of the LC threat system, paving the way for more effective treatments targeting this system.
• Efficacy of Neuropeptide Y in Response to Extreme Stress. Having discovered the potential role of neuropeptide Y (NPY) as a ‘pro-resilience’ molecule in the human brain during the first randomized, double blind, placebo-controlled study of intranasal administration of NPY in patients with PTSD, Mount Sinai faculty will build on this work by studying the effect of administering NPY in brain systems that mediate threat response among individuals who have suffered COVID-19-related stress. This work could result in novel therapeutic approaches for patients experiencing extreme stress. 
• Combining Ketamine with Brief Psychotherapy for Faster, More Effective PTSD Treatment: Ketamine, which acts as a selective NMDA receptor antagonist, has shown tremendous promise as a therapeutic agent for treating depression. This pilot clinical trial will explore the effects of combining ketamine administration with evidence-based brief trauma-focused psychotherapy adapted for COVID-19 survivors to treat severe PTSD. Based on pre-clinical and neuroimaging evidence that ketamine stimulates synaptic growth and increases connectivity in key brain regions, the hypothesis is that ketamine might enhance the effects of psychotherapy and help maintain improvements over time.

“Based on what we have learned about PTSD from the WTC Program, we estimate 25 to 40 percent of first responders and health care workers will experience PTSD as a result of COVID-19. The success of this program in understanding and addressing PTSD among Mount Sinai’s health workers will inform future efforts to refine, scale up, and adapt to care for our patients and their families in the communities we serve but also to better support health professionals at institutions throughout our nation and the world,” Dr. Charney says. “Ultimately, we hope it becomes a model for enhancing psychological resilience in frontline health care workers exposed to COVID-19, thus ensuring that health care systems nationally and internationally continue to deliver outstanding patient-centered care whatever challenges the future may bring.”

About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care—from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty and our physicians in the top 1% of all physicians nationally by U.S. News & World Report.

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