Anjali Sankar, Ph.D.

Fellow in Depression

Project Details


Hilary P. Blumberg, M.D.


Yale University


An early targeted psychobehavioral intervention for depressed adolescents at risk for bipolar disorder


Adolescence is a critical period for individuals vulnerable to developing Bipolar Disorder (BD), as this is often when initial symptoms transition to fully syndromal BD. It is also a time when the brain circuitry subserving emotion regulation, central in BD, is maturing. Research has shown alterations in the neurodevelopmental trajectory of this brain circuitry during adolescence in individuals who develop BD. Therefore, interventions that help realign neurodevelopmental trajectories have potential to prevent progression of BD. Non-medication therapies that improve emotion regulation and functioning of its underlying brain circuitry are especially needed for adolescents at-risk for BD (ARBD).

Sleep and other daily rhythm instabilities can be potent in precipitating and worsening emotion dysregulation, depression and manic symptoms. ARBDs are sensitive to these instabilities, which can be important risk factors for the onset of BD. Following a 12-week psychobehavioral intervention, Brain Emotion Regulation Circuitry Self-Monitoring and Regulation Therapy for Daily Rhythm Regularization (BE-SMART-DR), designed to target emotion regulation and underlying brain circuitry, our team observed improvements in emotion regulation and its circuitry, and reductions in depression, manic symptoms and suicide risk, in adolescents and young adults with BD. This KTGF Fellowship provides the opportunity to examine brain circuitry and symptom changes with the BE-SMART-DR in ARBDs who have mood symptoms, but have not developed fully syndromal BD. This could lead to early, targeted, and highly-disseminable intervention strategies focused on healthy sleep and activity patterns for youths that delay or prevent the onset of BD.

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