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[00:00:00]Dr. Sharp: Hey, what’s up y’all? This is Dr. Jeremy Sharp. This is The Testing Psychologist podcast, episode 70. I think you’re going to like this conversation. This is maybe a topic that you have not heard about.

I am talking today with Dr. Jenni Pacheco who has a Ph.D. in Cognitive Neuroscience and she is a Program Manager at NIMH, where she does extensive research in RDoC, Research Domain Criteria.

If you don’t know what that is, that’s totally okay. We’re going to talk all about it and let you know what it is. I will say that it is a research-based way of looking at psychopathology and differences in functioning that shifts our paradigm of how we typically see people and mental health concerns. So Jenni’s going to talk all about that with us and it’s a pretty cool conversation.

[00:01:00] Before we jump to it, I want to let you know about the clinical, administrative, and training paperwork packets that I have put together specifically for testing psychologists. You can find them at thetestingpsychologist.com/paperwork. Like I said, there are three different packets or if you want all of them, you can get them bundled for a little discount. Go to the website, check it out, and see if any of those will be helpful in your practice. You can use the code “podcast” to get 20% off your entire purchase.

All right, y’all. On to the conversation with Dr. Jenni Pacheco.

Hey, y’all. Welcome back to another episode of The Testing Psychologist podcast. I’m Dr. Jeremy Sharp. Hope y’all are doing well today. My [00:02:00] guest today is someone who I’ve been looking forward to speaking with for a long time, and it’s been a long time coming.

Dr. Jenni Pacheco and I have been in conversations trying to make this happen for two or three months now. We’ve had to work through a little bit of bureaucratic red tape, but I think that that is, it’s going to be totally worth it.

Jenni is going to be talking with us about RDoC. If you don’t know what that is, that’s totally okay. We’re going to tell you exactly what it is and why it’s relevant to our field. I’m super excited to talk with her.

Jenni, welcome to the podcast.

Dr. Jenni: Hi, thanks. Happy to be here.

Dr. Sharp: Very cool. I’m so thankful that you were able to take the time and we could make this happen. I mentioned the red tape. So Jenni is a Scientific Program Manager with the RDoC unit at NIH. [00:03:00] She also manages a portfolio of other grand projects but working at this government agency, it comes with some hurdles, I suppose, to be able to talk about what you’re doing with people not in that government agency. Is that right?

Dr. Jenni: Yeah, for sure. There’s definitely things that are going on here that we have to wait until we get final approval to let everyone know what we’re working on.

Dr. Sharp: Sure. I’m just so thankful that we were able to pull it together and craft hopefully a meaningful conversation for folks around RDoC and what that is, where it came from, how we can use it, and all sorts of cool things.

Dr. Jenni: Yeah, I’m looking forward to it.

Dr. Sharp: Nice. So, Jenni, you have a PhD in Psychology. That’s about as much as I know about your background aside from what you do right now. So could we maybe just lead and talk a little about how you got here, [00:04:00] what your experience looks like and what you’re doing day to day right now?

Dr. Jenni: Yeah, for sure. My route is probably a little bit more convoluted than most, although lately, that seems to be the norm rather than the exception. I have a Bachelor’s degree in Biochemistry and I got a Master’s degree right after that in Psychology. I stopped and worked for a little bit mostly doing fMRI and structural MRI data processing before I figured out exactly what I wanted to do with a PhD.

So I went to the University of Texas in Austin for my PhD. It was a Cognitive Psychology PhD. I was doing a lot of, like I said, structural and functional MRI, looking at healthy aging and various memory components of healthy aging and how the brain changes and how that changes [00:05:00] function. I actually was looking a little bit at minorly touching on resiliency, and so what are the differences between older adults that were having issues versus older adults that might have been performing or functioning more like younger adults.

So I did that for a bit. I went on to do a postdoc with the National Institute of Aging, which is up in Baltimore. I went down the rabbit hole of how difficult it is to study something like dementia. It plays a role in my career track and now being in mental health, there’s a lot of heterogeneity in the onset and development of dementia, which of course makes studying it a bit tricky. There’s some nuance there of how to be sure what you’re measuring.

I spent some time as well working on traumatic [00:06:00] brain injury, looking at changes structurally and how we might be able to treat the effects of traumatic brain injury before I ended up here at NIMH. It was, I don’t want to call it happenstance, but I think I was just talking to the right people at the right time when there was a position here with the RDoC unit.

Because I don’t come from a strictly mental health background, at the time I had heard of it but I wasn’t intimately aware of what RDoC was, but as it got described to me, it made a lot of sense given my background with imaging and trying to tie in a bunch of different measures to understand what was happening in some areas that are pretty broad and variable given dementia or traumatic brain injury, it all made sense.

So the opportunity to work with the NIMH and help [00:07:00] look at the broader field and the bigger picture and where we should be heading was exciting and intriguing for me as opposed to continuing to do my own research. So I’ve been here for not quite 4 years and it’s been great.

Dr. Sharp: Very cool. It sounds like you had the right place at the right time and stuck.

Dr. Jenni: Yeah. I’m glad for that.

Dr. Sharp: Sure. So I have to ask, when were you in Austin? I did an internship at UT.

Dr. Jenni: Oh, I was there from 2007 to 2011.

Dr. Sharp: Oh, that’s awesome. I was there 2007-2008 for a predoc internship at their counseling center. Very cool. That sort of thing just blows my mind. I think about, oh, that’s wild. Did we ever walk by each other on campus or something?

Dr. Jenni: Right, it’s strange. It’s funny how all of these little fields end up being really [00:08:00] small. And as you talk to people, they’ve all been in through the same places at some point. So I’m sure we did.

Dr. Sharp: That’s fascinating. Nice. I always say if I were to leave Colorado, Austin is at the top of the list. I enjoyed my time there.

Dr. Jenni: Yeah, it was a great place to, especially for graduate school, it was just a real nice place to be.

Dr. Sharp: Yeah, that’s wild. Anyway, we could go down that rabbit hole, I had some friends in graduate school there. Anyway, we won’t do that. So here you are, you’re the program manager with RDoC. I think there’s a lot to unpack here so I’m just going to get right to it. Can you just tell us what is RDoC? What does it stand for? What is it? Anything you want to tackle.

Dr. Jenni: Yes, so RDoC stands for Research Domain Criteria. [00:09:00] It’s always hard to answer what is RDoC. I think it’s helpful to have an understanding of where the need for RDoC came from or how it came about, but ideally, RDoC is a framework or a way to structure your research where instead of beginning with a syndrome and trying to drill down to find underlying mechanisms, we’re trying to focus on research that starts with disruptions in neurobiological or behavioral mechanisms and work across systems to see what the connections are among the disruptions and how those would relate to clinical symptoms and start with this more mechanistic or systems-level understanding of what’s happening as opposed to starting with a broader defined syndrome that might be defined by clinical symptoms or observable signs.

[00:10:00] I think the need for it came from, if you think about the burden of mental health or where we are in terms of developing new treatments or new understanding, I think our research there had, I don’t necessarily want to call it a plateau but I think that we had stopped making a lot of big advances and I think that was hindering the ability to come up with new treatments or new therapies that would be effective if we were slowing on our understanding of what the differences of these disorders are.

As NIMH’s main mission is to help research both basic and translational to further treatment and diagnosis of patients suffering with mental health, I think our inability to make a lot of progress was seen as a big problem. And [00:11:00] so in 2008, there was a new strategic plan for NIMH which called for new ways of classifying mental illnesses based on more dimensions of observable behavior and neurobiological measures.

And so in 2009, we’re almost coming up on the 10 years of RDoC, it’s when this whole idea was given a name and tried to give some meaning to this idea of how would research look different or how can we start looking at the same questions but maybe from a new way that would help uncover something that could lead to treatments or therapies that we haven’t thought of yet.

Dr. Sharp: So my understanding that this was born out of maybe an observation or a feeling that we had hit the wall a little bit with diagnostic research and being able to nail down what was going on with folks from a mental health [00:12:00] standpoint.

Dr. Jenni: Yeah. I think that’s exactly it. If you think about the psychopathology research was maybe just not keeping up pace with clinical neuroscience or behavioral science and that perhaps our cycle of research was getting hampered or slowed down by having these disorders with names that are pervasive throughout the entire cycle of research, publications, treatment, clinical trials et cetera.

They’re using terms like depression or schizophrenia, all of these diagnoses are helpful in clearly and easily describing who your subjects are for a research design but by using this sample, you’re [00:13:00] restricting the types of questions you can ask or the types of answers you can get because we know there’s going to be some variability in your groups.

If you’re just looking at things group by group, there’s going to be variability in your control population. There’s going to be variability in your patient population. And so what does that say for your results?

And so NIMH and RDoC is trying to ask people to maybe look at things in this more dimensional way instead of a categorical way. So if you think about the domain of functioning that you might be interested in to look at that, perhaps across different disorders, perhaps just across the full range of functions, so including your control or your typical group versus your patient population.

If you start looking at these domains of function, it’s a little bit easier to start classifying people on a continuum as opposed to trying to fit [00:14:00] them in discrete boxes or categories based on what the diagnoses would be in the clinic.

Dr. Sharp: Is it a stretch to say that we’re talking more like bottom-up versus top-down, I don’t want to use the word classification but that’s the only word that is coming to mind.

Dr. Jenni: No, I don’t think it’s a stretch and those terms get thrown around in a lot of different scenarios, especially recently. No, I think you’re getting at it and we can start with disorders that we want to try and explain, but if our underlying mechanisms, if our behaviors and our biology isn’t matching up with where those boundaries have been placed, we do a disservice if we don’t look beyond them.

So if we’re only looking within these boxes that were set up and not trying to [00:15:00] see, are there different boundaries? Are there new disorders within this one disorder? Is depression comorbid with anxiety, two different disorders, or is that one disorder? Are there different boundaries and can we use our tools that we now have to be able to look at systems within the brain or more genetic relationships or other ways of measuring things? Can we look at those to give us more signs as to where this function is happening?

Dr. Sharp: Just as we start to talk about it, I’m starting to reckon with the weight of what y’all are doing because I’m thinking to myself, how do you even know what to call whatever you’re finding when we’ve called it something this [00:16:00] particular disorder for so many years. How do you know what you’re researching? It’s just like upsetting the whole system that’s been in place for so long. How do you start to tear that down?

Dr. Jenni: I think you’re hitting on exactly the tension that came out with the introduction of RDoC is this overall sense of why, how do we do that? What do we do now? And so I think that for a while, that’s what NIMH and RDoC have been trying to address.

Our big focal point is the RDoC Matrix, which is on our website. The matrix came about as an understanding that we can’t just change the way everyone’s looking at research and not provide some guidance. We can’t let everyone just flounder around on their own trying to figure out exactly what we mean.

And so the RDoC Matrix came about as [00:17:00] a framework for people to be able to look at and understand what we mean when we’re talking about a domain or function, what is a psychological construct, what would that look like if we’re talking about measuring physiology or measuring behavior or neural circuits, what are the key players there?

And so our matrix that has … it’s broken into functional domains and each domain has underlying sub-constructs of a psychological phenomenon that can be measured. We’ve put up several units of analysis or ways to measure that construct. So we’ve got from the very basic molecular cellular levels all the way up to various physiological or behavioral measurements of that construct.

And the idea here was that this would help researchers do exactly what you’re saying is figure out what to call things or what [00:18:00] are the things that we’d want to look at when we’re setting up our studies or when we’re asking the questions that we want to ask. Certainly, we’re not asking that anyone completely ignores all the work that has been done in the past or even pretend like these disorders don’t exist or aren’t a thing, we’re just asking perhaps, and there’s many different ways to set up a study that would be RDoC but we were just asking people to think perhaps a bit more broadly and a bit differently.

So you might still be recruiting subjects from a clinical setting who come in with a particular clinical problem but you might use a different type of measure to set up your research group. So you might not just do patients versus controls. You might get people in who have a certain issue that you’re interested in, but then maybe there’s a different measure that you give to everyone in your [00:19:00] breaking on the performance of attention or cognitive control.

There’s something that you’re interested in and that’s going to define your groups. And now we’re going to start to look at what are the underlying mechanisms or systems that play a role in the different performances on that measure you’re looking at.

Dr. Sharp: Yeah. I was just looking at the matrix and if people haven’t checked this out, I’ll definitely put this in the show notes. I think my first reaction is that it is thorough and maybe on the foot, the other side of that coin is complex or complicated, but this is just my …

I don’t work on this every day by any means, but it also looks really cool. Can you explain that a little bit and say more about how y’all break things down and these [00:20:00] different, I’m not even sure you call them, dimensions or domains and how they all fit together in your research?

Dr. Jenni: Yeah. When RDoC first came about, it ended up being six but we had different workshops for each domain. And so the domains were decided on as these broad areas that are important for psychological functioning or psychopathology research. We had large groups of experts come together for several days to discuss how to break that domain down and what are the kind of psychological constructs that go into them.

And we wanted to try, there’s always this desire to find the right grain size, so we don’t want to get too specific and we don’t want to be too broad in what our constructs are but we do have some criteria that we tried to keep in mind of having things that were discrete from each other so they weren’t necessarily [00:21:00] overlapping or just measuring the same thing and that they did have some independent or separable system driving it so that you could independently interrogate a construct and that you weren’t necessarily always going to, by default, have another construct be getting in the way.

So that was how we tried to break things down. For sure, those groups, we tried to have a wide variety of expertise from the field, so both animal and human researchers, clinicians as well as non-clinicians to try and get as many sides of the coin as we could. Ultimately, our aim was to have everyone come to a consensus and this was an attempt to, like I said, give a starting place for people to see on paper what it was that we were talking about when we tried to introduce RDoC.

[00:22:00] The idea is that these are examples and that it’s not exhaustive. There’s, of course, things that are important for psychopathology that are probably not in the matrix. And that’s not because we think they’re unimportant, it’s just at the time, it was kind of we have to start somewhere and here’s where we’ve started.

The the plan was always for this to be an evolving updatable entity. It didn’t happen for a long time that we didn’t really update it and I think it’s for exactly what you’ve mentioned of, there’s this real big shift that we’re asking people to do and it almost felt irresponsible to put up this matrix and then start changing it right away. We needed to give the field and everyone more time to understand what was happening here.

[00:23:00] A lot of this happened before I joined NIMH, but I think it took some time for NIMH and RDoC itself to get comfortable and familiar with the matrix and understand what was there.

In the past two years, we’ve formed a council work group. So the NIMH has an advisory council, and through that advisory council, we’ve formed a council work group for RDoC whose purpose is to help us with changes to the matrix so that when we do want to add something or when we look at it and think, well, something’s missing here, we now have a group of experts who are… their job with us is to look at the changes that are being proposed and figure out how to make sure that they make sense, how to make sure we’re not missing something, change one thing and we make something worse. We want to try and update for the better.

And so in the past year, we’ve actually made several changes. [00:24:00] This May, they submitted some changes to reorganize the positive valence domain and make it a little bit more, the word I want to say is efficient but it’s just a little bit more straightforward and maybe follow some of the research a little bit more closely than what was there originally.

And actually just last week at our council meeting, we had approved an addition of a sixth domain. So currently there’s five domains. They’re negative valence, positive valence, cognitive systems, social processes, and arousal and regulatory. We’re just adding a sixth domain, that’s the sensorimotor system.

And so we had a big group work through that one and figure out what construct should be in that domain. We pushed that through our advisory council and they all approved that that was a good change. [00:25:00] They wrote up an extensive report and so we’re working on getting that report up to the website and then we can update the matrix to add that domain.

So we’re we are trying to update it and change it as the field moves and changes. It’s probably more indicative of the fact that some of this research is just slow, so we aren’t going to be making rapid changes. We’re going to probably be making slower, more thoughtful changes but that’s where we’re trying to be able to keep up with what’s going on in the field.

Dr. Sharp: Yeah, that makes sense. Of course, things move slowly sometimes. I’m just looking at this and I’m kind of a visual person so I’m thinking of folks who might be listening in the car or something, I want to describe this a little bit because I think it maybe hangs together when you can see it a little bit more where you [00:26:00] have this overarching umbrella, it sounds like of the matrix. And then within that, you have these five, now six systems that you’re looking at. You said negative valence, positive valence, cognitive systems, social processes, and arousal and regulatory, and then you said sensory and perception; is that right?

Dr. Jenni: Sensorimotor.

Dr. Sharp: Sensorimotor, sorry. So you have those systems and then under each of those systems, there are these constructs or subconstructs. For an example, under cognitive, there’s a construct of attention, language, and working memory, for example. And then for each of those constructs, you break it down across a number of different dimensions, I suppose, there’s the molecular, there’s cellular, there are circuits involved, there’s physiology, there’s behavior, and then there’s self-report and paradigms, which I’m not totally sure what that is.

There are many [00:27:00] different levels of, like you said, you get pretty granular with this, it seems like.

Dr. Jenni: Right. The matrix is exactly a matrix. So the way it looks on our website is the rows are these psychological constructs and the columns are what we call units of analysis and those are areas that you can interrogate each of these psychological constructs and ways that you can look at them. And like you said, they go from molecules, cells, circuits, physiology, behavior, self-report.

And then we do have this last unit of analysis that’s called paradigms which is actually, it’s not quite the same as the other units of analysis that overarches them, but that’s our attempt to offer some either behavioral tests or maybe an fMRI task or some other [00:28:00] measure that you can use with your subjects that would actually measure the specific construct that you were looking at.

We had a large work group several years ago that went through each construct in the matrix and looked at through the literature and what’s being done and tried to pull out the best types of tasks or measures that could be used for that construct that was reliably measuring what you would expect it to measure for each of the constructs of the matrix. So we have that listed as well.

Our push there is at some point, it would be great if we could have some continuity of measure and common data elements so that at some point we can combine smaller data sets into larger data sets, and there’s some systematic way that they’re measuring different RDoC constructs so that we can really start to pull some larger data and see [00:29:00] what’s happening.

Dr. Sharp: Sure. I wonder if we could make this a little more real. Can you talk to me about just the research that y’all are doing day to day and maybe even give a concrete example of how all this comes to life when you’re looking at different levels of functioning in these domains?

Dr. Jenni: Yeah, sure. Of course, at the NIMH, we’re the funding agency. So we are funding researchers out at different universities and in different situations who have research questions and we’ll fund those projects.

So RDoC itself, we had at the, I think five or six years ago at this point, a series of funding announcements where people could submit grants that were specifically looking at an RDoC [00:30:00] focused type of project. I want to say they can be on anything, so there’s a lot of focus on trying to, like I’ve said before, look at distinct psychological constructs as opposed to entire disorders and try and track the functioning across a whole spectrum of people who clinically might be normal or not have a diagnosis all the way through people who might be have severe disorder and try and see how the functioning or how the systems that work together for that construct might change or might be different depending on where you are on that spectrum.

There’s a lot of work that’s happening that’s looking within one disorder category trying to look at, are there different subtypes or [00:31:00] different biotypes that we can pull out by looking at some of these psychological constructs. So could we get maybe genetic differences in playing with a functional circuit that’s working differently in one population or subpopulation than another?

And does that help us either further explain a current disorder and how we might give us any examples of some better way to focus treatment or perhaps it would help us figure out this subset of person would respond better to one treatment versus another, and so that might help find new targets for new treatments or therapies?

So I think there’s a lot of different ways that the work is being done. Within NIMH, we have several different divisions. I work for the Division of Translational Research, and within our division, [00:32:00] our off-the-cuff number is that about half of our studies do have some kind of RDoC influence to them at this point, which is, for me, it’s great to see that people are trying to understand what’s happening.

Again, I think it will offer a lot of payoff down the road because if we can find subtypes or different cut points for different constructs that’s going to give us a lot more information about how to treat or who to treat or when to treat.

My program is in development and so there’s a lot of differences of doing research in a development mindset as well because some of these constructs will look very different in a five-year-old versus a ten-year-old versus an 18-year-old. And so trying to understand how some of these disorders develop [00:33:00] and change over time with the environment that the kids are in or just the different developmental stage that they’re at is also really important to see how that plays into ultimately hopefully treating or preventing some of these disorders down the road.

Dr. Sharp: Absolutely. Could we maybe take like a, I don’t know if it’s a specific disorder or some real-life example of what this might look like in the research? I’m aware that I’m afraid of saying something too simple-minded here, but like we mentioned before we started recording this overlap between depression and anxiety, for example.

I know that a lot of folks that listen probably are child-focused, I don’t think everyone by any [00:34:00] means. I run into a lot of kids who seem to have this overlap of, it’s like high anxiety with irritability with maybe some explosiveness but they don’t seem to be bipolar but they’re in that disruptive mood territory but it doesn’t quite fit. There’s a lot of these symptoms that seem to co-occur, maybe there’s some ADHD but I’m not exactly sure what’s going on. It seemed this model would be really helpful in that but I’m trying to translate it to real life, like how you might approach that or how you might design some research to get underneath that.

Dr. Jenni: Sure. I’ll talk about one thing first, then I’ll come back to some of the work that I’m familiar with that’s happening in the developmental world. There’s a large [00:35:00] project, it’s called BSNIP which I believe stands for Bipolar and Schizophrenia Network for Intermediate Phenotypes but we call it BSNIP.

And so that’s been done looking at bipolar and schizophrenia but they have some really elegant work that looks into these biotypes. If you were to group people based on these disorders, there’s several different clusters of people that would be included in this group if you just looked at everyone with bipolar and schizophrenia.

And so what they were able to do looking at some genotyping, looking at some measures of cognitive control and two other things that are right in the RDoC matrix, they were actually able to, and I’m [00:36:00] sure I have the statistics wrong, but I’m going to call it cluster. They may not have been doing exactly a cluster analysis, but they were able to cluster these groups based on the different and converging information and that has been helpful to identify subpopulations within this broader class of schizophrenia, bipolar, and psychosis disorders and to really help them figure out what are the specific deficits that these patients are having and ultimately, how can we address them in perhaps a more precision medicine type of way?

There’s a figure that we use a lot of times in our talks about this that I think comes right out of the BEAST Network. I’m happy to share that as well so you can put that in the notes of this podcast [00:37:00] too.

Dr. Sharp: Great. Thank you.

Dr. Jenni: And in a similar vein, the work that’s in my portfolio, like I said, I oversee a portfolio of primarily ADHD work. There’s some irritability or other disruptive behavior focus work, but a lot of it is focused in ADHD.

A lot of that is trying to understand more specifically what are the deficits and I know classically there’s like an inattentive type and a hyperactive type of ADHD, but what does that mean and what are the systems there and are there signs that we can see that might indicate which children would go on to have issues with their ADHD as they get older or are there some that we would see that they would have a remittance of their symptoms and maybe not need as much intervention?

I know that there’s some [00:38:00] work that’s looking at some of these cognitive deficits and have been able to isolate comorbid disorders and identify that some of these deficits are indicative of the ADHD and not any of the comorbidities and that can be used as a sign point as to where they are in this spectrum or dimension with their ADHD and how it will be evidence as who might need to be treated sooner rather than later in terms of ADHD.

Dr. Sharp: Mm-hmm. So I’m thinking about how you put this research together. Do you take folks who maybe already have existing diagnoses and then, I’m not sure whether measure [00:39:00] across each of these different constructs and dimensions and see what shakes out compared to controls or are you going at it from the other side where you just take everybody and measure across constructs and then see what emerges in terms of differences or deficits or how do you structure the studies?

Dr. Jenni: There’s any number of ways to set up your study that would be considered RDoC in nature. I think the most important thing as with most research, is to have a really clear question that you’re trying to answer. A lot of the questions that are out there now lend themselves pretty easily to looking at things in a more RDoC-centric way so that we might look at something as opposed to comparing a control group [00:40:00] to a patient group, you might just look at your whole group and look at comparisons of this dimension of functioning and how does that relate to, say, a clinical outcome or a real-world outcome or …

So depending on what your question is, I think your variables will be pretty easy to select but there are certainly people who are trying to do this more less categorical, less group comparisons, and maybe something that’s more continuous in nature to try and see again, just with the way that people are normally classified into their different diagnoses, there’s probably a large portion of your control group that is probably subclinical, so they’re not passing a threshold to have a diagnosis or they maybe don’t have enough dysfunction for it to be really severely getting in the way of their daily activities but does that mean that [00:41:00] they’re completely without, are they completely asymptomatic or is there some range there?

I think for most of our mental health disorders, our control groups are people who don’t have a diagnosis. There’s going to be still a range within that group that we’re probably missing a lot of information by grouping them all together and saying that they have none of the issues that your patient group has.

Dr. Sharp: Yeah, that’s a great point. I think that’s something that we run into a lot from an assessment perspective is that clinical threshold. So kids or people who have who have symptoms but they’re maybe not exactly meeting criteria as they’re set forth right now. That’s hard. It’s like there’s something going on, but it’s, what do we call it because it doesn’t quite meet the criteria.

Dr. Jenni: Right. I [00:42:00] was listening to one of the past episodes where you were talking about testing in a university setting. I think they were mentioning that sometimes after doing the testing, you might not be able to come up with a diagnosis, but he was saying he was still keeping notes about what the functional deficits were so that just because I haven’t given this student a diagnosis doesn’t mean that everything is going to be completely easy for them and they can go on like normal, there may still be things we can do to help make some things easier.

As I was listening to that, I thought, oh, that really lends itself well to our RDoC focus where we’re looking at different systems and how they’re interacting or not interacting. And so you might be able to identify a deficit that doesn’t have a name and may not for [00:43:00] diagnostic or billing or anything else be able to be called anything, but it certainly doesn’t mean that they’re performing the way you would think someone would perform if they’re not having a difficulty.

Dr. Sharp: Right. I’m just thinking through, I have this question that feels vague but I’m going to throw it out there and trust that you can help sort through it a little bit. My question is, how does this all translate to real life and to practitioners where … it seems like a lot of the research that you’re doing or a lot of the underlying pieces that you’re looking at are physiological, molecular. Measuring those things seems to require a lot more than we have at our disposal in real-life practice, outside of a research setting.

So [00:44:00] how would we translate all of this, even if we know that there’s some type of ADHD that looks like this across these different dimensions, how we get at that in our practices. Do you have any thoughts on that?

Dr. Jenni: I have some. I myself am definitely trained as a research scientist, not a clinician and so I haven’t had to spend a lot of time thinking about it on that side. Of course, ultimately that is the goal of all of this research is to help patients. And so we do have to keep some of that in mind.

One of my longer-term answers is that the goal of RDoC is to get a better understanding of what’s happening so that ultimately, and again, this is a slow-moving process, but ultimately we might be able to help with modifying or [00:45:00] updating some of the diagnostic criteria that are happening in the clinic. So ultimately we might be able to get some tools into the clinic.

We’re certainly not there because research is slow moving and we need to make sure things are the way that they look before we can put them into the clinic. I think there’s a way to think about things on this more RDoC level when you’re in the clinic. I’ve recently come across a paper where they’ve done a case study of someone based on the clinic and they tried to look at it through an RDoC lens.

And so they did all of their testing and went through the normal procedure that they would do anyway and then they looked at each of the [00:46:00] domains of the RDoC matrix and said, okay, what are the issues that this patient is having in the negative valence system? What are the issues in positive valence? And they tried to go through there and pull out the things that that patient was having trouble with.

The end of this case study basically said they were able to almost more acutely or precision treat that patient because there were a few subconstructs that came out as oh, this is something that this person is having trouble with that might not have come out from just a diagnosis of say generalized anxiety.

And so it might not have been a focus of their treatment plan moving forward, but having looked at all of these psychological constructs, they could identify a few extras that, oh, we can work in treatment on this, or we can work this into our plan and ultimately have perhaps a better success at [00:47:00] the end because we looked at some of these different constructs that might not come out from a regular treatment plan.

Dr. Sharp: Yeah, absolutely. I would imagine that’s where we’re trying to go. Anything that we can do to increase our diagnostic precision and accuracy is the name of the game.

This whole thing is so fascinating to me because right now we have a lot of discussion, there’s a Facebook group that corresponds to the podcast and it’s about assessment clinicians and there’s a lot of discussion about how right now we don’t know that there’s a cognitive profile that defines ADHD, for example. We just have all this data at our disposal but it’s hard to know what it means.

Dr. Jenni: Yeah. [00:48:00] Two of the projects that I’ve seen that are funded through NIMH in the last few years are trying to make this association between what you referred to as the tests are things that are easier to do in a research setting and not so easy to do in a clinical setting. So I think one of the pieces here and how RDoC can really help in maybe a shorter term is by using say imaging or EEG or any of these things that we can do in a lab that are not so easy to do in the clinic, if we can understand what those are showing, we can start to figure out better, what are the tests that are easier to do in a clinic that would tell us what’s happening in this EEG?

So if we can understand what’s happening in the physiological systems, how do we now get a test that we can [00:49:00] administer in the clinic that might give us an idea of what’s happening underneath? And those are probably going to be really useful because you’re not going to roll an fMRI machine into your clinic and ask every patient to get in there so you can look in their brain but if we can understand how do results on certain tasks or paradigms that are more easy to administer relate to the systems underneath. I think that that’s probably more attainable goal of how we can get something that’ll be more informative.

Dr. Sharp: Yeah. I would love to see that. I would love it. I think a lot of people would. This is really cool. I love that this is happening. So that brings up like a, I don’t know what you call it, maybe a publicity question. I feel like I had to dig a little [00:50:00] bit to find any information about RDoC or even stumble across it. How do y’all approach that in terms of letting people know? Maybe I’m just living under a rock, but is it more well-known among researchers or practitioners?

Dr. Jenni: My guess is it’s probably more well-known for researchers mostly because as a funding agency, most of them feel like they have to do what we want so that they can get some money. So I think it started with the research and that’s our goal with it. I think more and more, as it’s becoming a little bit more commonplace in the research and in training researchers and clinicians, I think they’ll come across this more as they’re getting into it.

I think [00:51:00] we’re perhaps hitting the new generation of scientists and psychologists or psychiatrists as opposed to maybe from the clinic coming in and getting the people who’ve been there for a long time, we’re coming in through the bottom.

I think that, as we said from the beginning, it’s a big overhaul of how everything has been done and so it’s hard for us as the RDoC unit to always know how to market RDoC and how to do it because we can’t answer everything yet. We don’t have anything to hand over to clinicians right now to say, here’s how we can make your life easier. It’s a little tricky to how extensively do we really want to go after clinicians if we can’t quite help them yet. [00:52:00] We can help researchers try and find and answer questions that will ultimately get there.

As I said, we’re almost at 10 years of RDoC, I think the first 10 years was really trying to get this to take hold in the research world and now I think we have to start redirecting our focus because we have to always be looking ahead. We have to always be looking at where this is going or where the field is going and how can we help that.

And so I think now we have to start looking, someone asked recently how we know when RDoC is done and we can update diagnostic criteria. I don’t have the answers to that, but I think as a field now and us as the NIMH, we can start thinking about, okay, what would it take for us to be sure that we have something that we can pass into the [00:53:00] clinic or pass back to people who are in the trenches trying to help people who have disorders that they need help with.

Dr. Sharp: Right. So maybe we could start to close with a question around that, which is, at this point, is there anything that you feel like we can take from RDoC to incorporate in our day-to-day practice? Even if it’s just a mindset shift compared to a concrete, like a measure or a diagnostic criteria. Is there anything that we could take from it right now and use that in our day-to-day practice?

Dr. Jenni: Sure. So we actually just had on the past two days, we had a meeting here of training directors and some of their trainees. So some of them are more clinically focused and some are more research-focused. One of the things that someone said to me that struck me was that, as a clinician, you’re [00:54:00] taught and trained in these very almost rigid diagnostic boxes and you’re tested on them to be sure what’s happening, but that day to day in the clinic, people don’t always fit into those boxes and you’re not sitting there thinking in terms of those things as more as you’re probably are sitting there thinking more of these psychological constructs and what are the building blocks that this patient who’s in front of me is having issues with and where do we need to focus?

I think it sounds like a lot of the differences between RDoC research and what’s happening in the clinic is perhaps just like a bit of a language thought organization thing in that RDoC is probably a little bit more focused on neuroscience [00:55:00] than things in the clinic or how we’re testing people are but I think some of the methods are similar.

For me as part of the RDoC unit, I find it helpful to get some feedback of, if we called it social communication, what would someone else call it or this is the term and the circuit that we’re using but are we thinking of the same thing? We’re just calling it different things. How can we bridge this gap between what terms you’re using and what terms we’re using?

I think that trying to look at the smaller psychological constructs and how they relate to each other in each patient is probably the first step in trying to think RDoCwise in the clinic.

Dr. Sharp: Sure. [00:56:00] I really appreciate that you were willing to come by and chat about all of this. I feel like it opens up a whole other set of criteria for looking at people. I think a lot of us will probably say that this is long overdue.

Dr. Jenni: Yeah, I’m glad to do it. I think there’s often a lot of, I don’t want to always say it’s misconceptions, but again, depending on how you’re trained and how these things are taught initially, this is a big shift in how to think about it, but ultimately I think it makes a lot of sense to a lot of people on the research side, people on the clinic side that this is following a little bit more of how people are.

Of course, when we started doing a lot of this research and our tools weren’t where we are today, a lot of [00:57:00] the assumptions and the way that things were set up made a lot of sense, and I think that RDoC is just trying to help the field keep up with the tool development and how we can implement that to try to push forward with new treatments or new therapies that might be able to help more people.

Dr. Sharp: Sure. Well, I think that’s the way that things are going. Everything these days, rightfully so, is more, it’s really looking at biology and neuroscience and it just doesn’t make sense anymore to be doing the work we do without that scientific grounding that we just haven’t had for the past several years. I’m glad you’re doing it.

Dr. Jenni: Great. Thank you.

Dr. Sharp: I know that you have a little bit of an exciting [00:58:00] announcement, I guess. Y’all just published a funding announcement and I would love to have you talk about that if you would like to.

Dr. Jenni: Yes, we just had a funding announcement come out on Friday. I had made mention of a work group that two years ago focused on tasks and measures and how we could really measure each of the constructs in the matrix.

One of the big conclusions of that group was that there are a lot these tests that are being used or tasks in research, and we haven’t done a lot of the groundwork that’s needed, so we don’t always know what the psychometric properties of each of those tasks are. We aren’t always sure that we know that it’s measuring what we think it’s measuring. A lot of that work, of course, it’s not pretty. It’s not going to get you a giant publication [00:59:00] but it’s needed.

And so we finally have a funding announcement out that’s asking people to focus exactly on that. So it’s for new task development or task optimization to try and make sure that we have tasks that are here and able to be used, that are working, that are measuring what we want to measure in a way that we understand and that we can trust the data that comes out of them.

I know you said you could post the link to the funding announcement but we’re excited to see some of the work that can come in because I think moving forward will be helpful for the field to have a bunch of tasks at their disposal that they can be sure they know what data they’re collecting from them.

Dr. Sharp: Yeah, absolutely. I’m happy to do that. So that will be in the show notes too for any of you out there who are researchers [01:00:00] and might want to participate there. I know that we have a fair number of university folks out there and faculty members who are involved in research programs so happy to go that link out there as well.

I wonder if we could close just with if people have questions, what’s the best way to get in touch with you or is there someone else to get in touch with? If they just want to get more information about RDoC, where is the best place to do that?

Dr. Jenni: Sure. I would be happy to take any emails. We do have a website on the NIMH website that’s focused solely on RDoC. We also have an RDoC Twitter feed. Our Twitter handle is @NIMH_RDoC. And so you can find us on Twitter.

We do have on our website email address listed too that’s [01:01:00] just goes to a general inbox so that a bunch of us could check it if no one else is answering email. So that’s rdocadmin@nih.gov. We’re always welcome to get any feedback or hear any questions or if anyone is having trouble getting started, we’re happy to… that’s what we’re here for. We’re here to support the researchers and anyone else in the field who’s trying to move things forward.

Dr. Sharp: Fantastic. Thank you so much for coming on and talking with me. This is super enjoyable and it’s piqued a lot of interest for me. I’m going to look at that matrix a little more and see what’s going on there. I’ll be looking forward to hearing more about RDoC in the coming years.

Dr. Jenni: Great. Well, thanks for having me.

Dr. Sharp: Okay, y’all. Thank you so much for listening to this episode as always. I haven’t given a shout out [01:02:00] for subscribe rate and review in a while. If you haven’t done that, that would be awesome. That’s how the podcast gets bumped up the charts in all of those podcasting places. Take 20 or 30 seconds and subscribe. You won’t miss any episodes, and rate and review if you are feeling extra generous, I’ll always appreciate that.

If you have any thoughts about how to build your testing practice, if you need any coaching, any advice, I would love to help you with that. That’s what I do. You can explore that option at thetestingpsychologist.com/consulting. We can schedule a 20-minute complimentary pre-consulting call just to see if that is appropriate for you. If it is, that’s awesome. I’d love to work with you. If not, I’ll try to hook you up with any other resources that might be more helpful. So that’s thetestingpsychologist.com/consulting.

All right, [01:03:00] y’all, take care. Got some great interviews coming up on the horizon so stay tuned, subscribe and we’ll see you next time. Bye.

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