Bending not breaking: Christine Rabinak’s PTSD research persists through the pandemic

Developing new ways to conduct research during a global pandemic is not the sort of discovery Christine Rabinak had in mind as she embarked upon her most recent study. But when the Eugene Applebaum College of Pharmacy and Health Sciences associate professor had to lock the doors of her Translational Neuropsychopharmacology Lab and send her team home in late March 2020, Rabinak knew a different type of innovation was in order.

Associate Professor of Pharmacy Practice Christine Rabinak

Like so many of her Wayne State University Department of Pharmacy Practice colleagues, Rabinak rolled up her sleeves and worked with her TNP2 Lab team to re-imagine processes, retrofit logistics and amend the IRB for her prolonged exposure (PE) therapy clinical trial in adults with post-traumatic stress disorder (PTSD). The study aims to determine whether the use of cannabinoids during PE therapy could help patients more effectively process traumatic experiences to reduce fear and anxiety.

“We’ve always had to alter approaches with any study, but this is such a drastic change in the environment. How do I still maintain scientific rigor and answer the questions posed but keep patients and staff safe while providing treatment?” said Rabinak, whose primary research focus is on trauma and overcoming PTSD. “Over the past several months, we’ve learned to be very flexible with two levels of contingency plans at any one time.”

As Rabinak pivoted, she was concerned not just about her research findings but with maintaining the benefits to the study participants themselves. “We were going to be offering participants access to PE therapy, a gold standard PTSD treatment not yet broadly available,” she said. “I was super excited to provide this much-needed therapy to Detroit veterans and other patients at no cost.”

TNP2 Lab team in 2017
TNP2 Lab crew members at the May 2017 Translational Neuroscience Program Symposium and Research Day.

The original plan was for collaborator Dr. Sheila Rauch — an Emory University professor of psychiatry who specializes in PE — to travel from Atlanta to train therapists in Detroit over the course of six months. Once certified, these professionals would follow the standardized protocol to help participants discuss and emotionally process their trauma during 12 sessions in the TNP2 Lab.

“PE therapy is an incredibly effective process in its entirety, but there is significant dropout,” Rabinak said, explaining that the more a person talks about their trauma — each time they face it and nothing bad happens — the more manageable it becomes. “Patients may do well during their session but storing and recalling those feelings is tricky.”

Rabinak theorized that activating the brain’s cannabinoid system with very low doses of synthetic THC — an amount so small that most patients can’t tell whether they’ve gotten a pharmaceutical or a placebo — would encode the progress made in therapy.

Christine Rabinak works in her lab
The PE therapy clinical trial will include MRI scans and virtual reality tasks to evaluate therapy results.

“We focused on the cannabinoid system because it contains the highest number of brain receptors,” Rabinak said. “We know that many PTSD patients attempt to self-medicate with marijuana, but they only see benefits as long as they stay on it and it’s in their system. I want to give them back control of their life, and help them use cannabis not as a Band-Aid but to remedy the root cause of the problem.”

When the pandemic prevented Rauch from traveling to Detroit, Rabinak’s workaround was fortuitous: Now study participants will receive their 12 therapy sessions directly from PE experts like Rauch and her postdoctoral clinicians via telehealth appointments. Following all mandated safety protocols, participants will receive either a dose of THC or a placebo before the TNP2 team situates them in a room alone and connects them to Atlanta for their PE session.

This is just one example of how innovative Rabinak and her team have been to keep their study moving forward, with each solution seeming to arrive with a silver lining.TNP2 Lab logo

“The pandemic really hit at a bad time,” said TNP2 Research Coordinator Allesandra Iadipaolo. “When we had to grind to a halt and move all operations remote, it was difficult at first, but we quickly started doing the behind-the-scenes work to ramp up in a new way. By reworking the protocols significantly, we’ve found some procedures that could carry forward, like interviews previously done in person that now occur remotely, which may improve attendance and help participants remain in a study down the line.”

Team effort

Iadipaolo joined Rabinak’s crew in 2016 after graduating from WSU with a bachelor’s in psychology. Although she had participated in plenty of research across campus to that point, she was taken aback by the interdisciplinary nature of the TNP2 Lab, calling it nothing short of revolutionary.

Rabinak is committed to mentees such as Research Coordinator Allesandra Iadipaolo (left) and Undergraduate Research Assistant Shelley Paulisin, shown in 2018.

“Christine is absolutely brilliant, she’s wonderful at her job and she cares about people. She is just as devoted to fostering her team’s development as she is to the research itself,” Iadipaolo said, adding that Rabinak is currently helping her apply to graduate school out of state, knowing full well that success will result in the loss of a valued employee.

Iadipaolo was initially an unpaid volunteer but impressed her boss so much that after just a few months, Rabinak said, “I need to hire you. You’re really good and you should be getting paid.”

Four years later, Iadipaolo has worked her way up from assistant to full-time coordinator, saying, “Christine saw potential in me and allowed me to take on more responsibilities. I’ve learned so much and received training in so many things, like phlebotomy. Now I have an arsenal of skills I wouldn’t have otherwise had the opportunity to develop.”

In March 2018, the TNP2 Lab crew expanded young minds during Brain Day in Detroit at the Michigan Science Center.

Being able to call the shots in her own lab is a major reason Rabinak chose Wayne State over other tempting opportunities in 2014 after completing her education and a postdoctoral research fellowship at the University of Michigan. Having to separate from the close-knit team she’d worked so hard to create made the beginning of the pandemic particularly painful.

“I made sure everyone knew that I wasn’t expecting them to be productive, and that I wanted them to focus on taking care of themselves,” Rabinak said. “We’ve stayed in touch through Teams meetings and an ongoing group text, and our conversations aren’t limited to work. We talk about feelings, stress, isolation and fears. Mental health during this time is so important.”

By all accounts, for as long as Rabinak has run her lab, she’s done so with care for those who help keep it humming. For example, during non-pandemic times, she hosts a summer barbecue for employees, collaborators, family and friends, where she lists off her team’s personal and professional accomplishments from a running Word doc she adds to whenever babies are born or papers are published.

Beliefs are clearly stated in the TNP2 Lab.

Her methods have not gone unnoticed. “Dr. Rabinak has been an invaluable member of our department. Her research has garnered national recognition and created rich experiences for students at all levels,” said Associate Clinical Professor and Pharmacy Practice Department Chair Lynette Moser. “She has been dedicated to innovations in her teaching that demonstrate the value of research and good science to our pharmacy students and beyond.”

When Rabinak took 10 people from her lab, including undergrads, to New York City for a scientific conference around the time she earned tenure in 2019, the team presented her with a novelty #1 Doctor trophy.

“We really are like a family,” Iadipaolo said. “We’re better than family. We’re like a fun club that just happens to do important research.”

Rabinak says the support she feels from WSU Applebaum leadership is key. “I am so happy at Wayne State,” Rabinak said. “I can honestly say that choosing to come here is one of the best decisions I’ve ever made.”

During non-pandemic times, the TNP2 Lab team enjoys gathering for after-work fun, such as this 2017 Christmas party.

 

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