Episode 32: Bethany Teachman, PhD
The following interview was conducted during the Spring 2024 session of Hidden Figures: Brain Science through Diversity, taught by Dr. Adema Ribic at the University of Virginia. Student interviewers were What follows is an edited transcript of the interview, transcribed by Samantha Cecilia Anderson, Jocelyn Truc-Lam Pham, Vyshnavi Sistla, Olivia Paige Chapman, Salma Meraj, George Childress Quillen, Alex Liff and Elina Rastegar, who also drafted Dr. Teachman’s biography. The final editing was by Dr. Adema Ribic.
Dr. Bethany Teachman is a distinguished Clinical Psychologist whose research specializes in studying anxiety disorders and technology-based assessments and interventions to reduce anxiety. She received her Bachelor of Arts in Psychology at the University of British Columbia in Canada. Then, she obtained her Ph.D. in Clinical Psychology from Yale University. Currently, Dr. Teachman is a Professor of Psychology and Director of Clinical Training at the University of Virginia (UVA). At UVA, she runs the Program for Anxiety, Cognition, and Treatment (PACT) Lab which studies how biased thinking contributes to anxiety disorders.
Can you explain your childhood and where you grew up?
I was born in Toronto, a large city in Ontario, Canada, as one of eight siblings. Even when I was in high school, I was interested in “helping” professions and I volunteered with the youth with different developmental disorders and behavioral disorders. At this time, I was really interested in learning more about that field, but I had no idea about research or about different career paths in it. Outside of this, I was in a dance company which I really loved so much of my focus was spent on dance as a child.
Where did you go for undergrad and was it then when you became more interested in psychology?
I decided to attend the University of British Columbia on the West coast of Canada. While there, I started taking some psychology classes. I became a psychology major and started to become increasingly interested in research through some of those experiences. In my third year of college, I did an exchange year at the University of Melbourne in Australia. My time abroad was an extremely formative experience for me. One of the main reasons being that I became friends with a graduate student who was currently pursuing a PhD at the time. Through this friendship, I began to learn more about PhD graduate programs and became intrigued by the thought of pursuing a PhD myself. I went back to the University of British Columbia for my final year of college to find a position as a research assistant. I became incredibly lucky that Dr. Jack Rachman, who unfortunately has recently passed away, took me on as a research assistant. His lab was really fun, making my time there a really great experience. His particular lab studied anxiety and OCD, and I found it really, really fascinating. I also got to work with a fabulous group of people within the lab. At the same time, I was doing an honors thesis, but I was doing it in the area of moral psychology and moral development. Although my thesis was not focused on clinical psychology, I realized at this time that I was actually more interested in the clinical realm of psychology and more specifically the study of anxiety and eating disorders.
What was your path like after undergrad?
When I graduated, I stayed in British Columbia for one year working as a project coordinator in the same lab that I worked as a research assistant in during my undergrad. During this time, I got more involved in research and knew that I wanted to pursue a PhD in clinical psychology. The following year, I was accepted at Yale University to work with Sheila Woody. It was a really good fit in terms of research match and opportunity. My second day there, I met the person who would become my husband. He was actually doing the welcome orientation for new students. He was a year ahead of me and also doing a PhD in the social psychology program.
Have you noticed any technical or social differences in academia between Canada and the United States?
Yes, there are definitely differences that I personally noticed. For one thing, the college application process is a little calmer in Canada than it is here, as it feels very intense. There is definitely a sense of competition and overwhelming stress when it comes to applying for college in Canada, and probably more so than when I went through it, but it definitely feels more intense here in the U.S than it was in Canada. There are also differences tied to funding models for both college and PhD in terms of how much college costs.
What type of research initially interested you when you got into the field of psychology, and has that changed throughout the years?
Initially, I was drawn to unraveling the decision-making processes of individuals experiencing clinical issues, such as those with panic disorder who hold irrational beliefs despite contradictory evidence. For instance, I have encountered people who’ve had many panic attacks but still believe that they are going to have a heart attack on the next one. However, the frustrating realization of the inadequacies in our mental healthcare system, where the majority of people never receive help despite available interventions that can significantly improve their lives, shifted our focus towards creating more accessible approaches, particularly through digital mental health interventions.
What core questions have remained central to your work in psychology, despite the evolution of your research throughout the years?
Although our research has evolved throughout the years, the core questions that initially intrigued me remain central to our work. I've always been fascinated by understanding how individuals think differently when facing emotional dysregulation, such as anxiety, and how we can facilitate healthier thinking patterns. Additionally, accessibility to mental health care for a greater population has been a driving concern. The inequities within the healthcare system have further motivated us to ensure inclusivity in reaching and providing care to all individuals. As our team has grown interdisciplinary, incorporating expertise from psychology, engineering, and computer science, our methods and approaches have evolved significantly, allowing us to ask more nuanced questions and develop innovative solutions to address mental health challenges.
What area does your research primarily focus on, and what are some key findings from your lab in this domain?
Our research explores how biased thinking contributes to anxiety disorders, with a focus on interventions to shift thinking patterns. We've found that cognitive flexibility training can reduce anxiety and emotional dysregulation, even without therapist involvement, improving access to care. These interventions, demonstrated across large community samples and clinical trials globally (in more than 85 countries), underscore the causal relationship between cognitive processes and anxiety reduction. Additionally, our work on implicit associations in memory has shown their significance in psychopathology. Treatment-induced changes in these associations predict treatment outcomes, highlighting their role in understanding and alleviating clinical problems.
Could you elaborate on the significance of implicit associations in memory tied to psychopathology, and how they are addressed in your research?
Yes! A key area of focus in our research is understanding automatic or implicit associations in memory tied to psychopathology. Through Project Implicit Health, we've analyzed over a million tasks, revealing automatic associations linked to various clinical problems. Early work has shown that treatment can alter these implicit associations, with changes predicting treatment outcomes, particularly in panic disorder. These findings highlight the significance of two key factors in understanding and addressing clinical problems. Firstly, they underscore the critical role of interpretation bias, wherein individuals tend to assign negative and threatening meanings, particularly relevant in anxiety disorders. Secondly, they emphasize the importance of implicit automatic associations, which represent rapid and involuntary ways of processing information. Both factors are essential for comprehending clinical issues and devising effective interventions to alleviate them.
When you started to implement and study technology-focused interventions, did you encounter pushback from others in the field who didn’t believe in the efficacy of these types of interventions and how have these opinions changed over time?
Absolutely, the first time I heard about some of these intervention approaches, I myself thought it was crazy! The fact that we could shift thinking patterns this way, it was totally novel. First, attitudes toward digital mental health have shifted dramatically in recent years, especially those following COVID-19. Initially, no one was using these approaches. Then, it shifted very quickly and these interventions were being implemented much more widespread. There’s been dramatic shifts in a short space of time, both for the work we do in cognitive bias modification and the work we do more generally in digital mental health.
What’s your strategy for dealing with any skepticism that exists toward mental health intervention in the digital sphere?
I invite skepticism. I don’t think our interventions are as strong as they need to be, or in the final forms I hope that they will be. We have to make our approaches to intervention much stronger, and we have to make engagement in digital mental health much more robust than it currently is. Because of this, the skepticism that people have is really valuable and important. If we’re going to be a strong clinical science, we have to constantly question what we’re doing and seek to prove what we’re doing. This is a healthy part of science and what it makes it improve. We always want to suggest that we are taking steps forward with each study done, but we have a long way to go in order to have interventions like this fulfill their promise.
What do you see as the biggest challenges other than adherence to these different types of technological interventions?
For cognitive bias modification, we’re good at shifting the inflexible negative thinking patterns. Often that translates to reductions in anxiety symptoms, but not always. I think we need to do a better job in getting that transfer of learning from a shift in cognitive change to a shift in symptom reduction. This is a challenge for the field to improve the programs to be more effective in that way. For digital mental health, there are really big problems in terms of implementation and engagement. Making digital mental health interventions work in existing healthcare systems has been really challenging. Getting people to start these programs and stick with them so that they can get the full experience has also been really challenging. We have a lot of work to do as a field to make these programs more effectively meet community members’ needs so that they want to use them.
Do you see a difference between age groups when it comes to who is more likely to use technology based interventions?
There are definitely some differences. However, I think about it more in terms of digital literacy and digital comfort than age. It may be that individuals who are older have less experience working with digital technologies, but there are also groups of individuals who are less likely to engage because of privacy concerns. This doesn’t always tie to age necessarily. There are often many different reasons to explain this hesitation to engage. We also have differences tied to cultural norms regarding the acceptability of these approaches and whether or not individuals feel comfortable working on their mental health. Overall, there are a variety of reasons why we hit barriers for different groups. Age is one, but certainly not the only one. For example, there are rural communities that may not have strong broadband access to mental health care. Additionally, some individuals don’t have access to a laptop or computer which may also be a limitation for these types of interventions. I think we need to be really careful that we don’t repeat the same healthcare disparities in the digital mental health space as we’ve had in every other area of health care.
Since the onset of the COVID-19 pandemic, there has been significant discourse on its social impact, including increased isolation and social anxiety. Have you observed any changes in anxiety levels before and after COVID-19 in your research?
Yes, we know that there have been increases, but the data is complex. For example, among young adults, we’ve seen large rises in levels of anxiety and depression. This was seen particularly among girls and women. For a lot of people, COVID-19 led to an increase in their anxiety levels initially, but then their levels returned to the baseline rapidly. We didn’t see long term effects across the board. Studies disagree on what exactly the story is, but I think we’ll learn more over time. It’s important to acknowledge the positive side of this. We’ve observed a greater willingness for people to talk about mental health issues that were present already and to seek support for themselves. We’re simultaneously seeing an increase in the prevalence of these problem areas and people being more comfortable talking about it, which is a good thing to reduce stigma.
How do you utilize passive sensing in your research?
In our Sapien study, we’re recording audio and other physiological measures. Instead of recording the content and semantic meanings, we’re recording pitch, tone, etc. People are comfortable with having pitch and tone recorded, but have concerns about the idea of people coding what they say in conversations. Our engineering team has done a lot of work to try and isolate these different effects. It’s been interesting to observe who has privacy concerns, who doesn’t, and how that plays out. A lot more work is needed in that space, particularly in areas of anxiety disorders where individuals with social anxiety have fears of being evaluated and performance concerns. However, we know almost nothing about it.
How do the ethical considerations regarding passive sensing or protective measures for these technologies and interventions affect your research?
It varies largely. We currently have a bioethics grant under review right now, which will be used to do interviews with individuals with social anxiety to understand their views towards the different wearables and passive sensing. We want to understand what these individuals are more or less comfortable with in terms of passive sensing. The grant is focused on trying to understand this better through interviews. We’re trying to understand not just what people say they want, but also what of these possible things we can measure. Is it really worth measuring because it will increase our ability to get interventions to individuals at the right time, for the right person, and in the right context for their needs? There are some things that we are going to measure that are going to be really useful and others that are not as useful, of which we can then let go of. Some of the things we measure are easy to de-identify, such as accelerometer movements, and some that are much more difficult. For example, GPS can be used to look at patterns over time and can tell you where someone’s home likely is which is identifiable. We need to learn which things are really worth getting data from in order to determine what will make a big difference in our ability to help people and which things we cannot do because they add privacy risks and don’t add enough to the model to make them worthwhile.
Is the focus of digital and mental intervention on individuals who don’t have the economic status to be able to go see a psychologist or therapist and pay for these services per hour?
I think the focus of these interventions are broader than just individuals who lack the financial means. In our data, a wide variety of people are choosing to use digital mental health resources, not only those where finance is the issue. I think more about stepped care models. For some people, digital mental health may be sufficient on its own. For many others, it will be helpful as a complement to other forms of therapy or interventions. I’m really interested in understanding whether these interventions can increase the efficiency of care-delivery models. For example, instead of someone needing to see me 12 times, perhaps they can see me only 6 times by using a digital mental health support tool that can enhance the effects of what we’re doing and get them part of the way there.
Do these interventions affect waitlists for professional care?
These interventions are useful to reduce these waitlists. Loads of people are stuck on waitlists, trying to access care, and we know that a lot of people don’t end up following through in these difficult and time-sensitive situations. Their symptoms can worsen, so we can offer them these supports to help them get through that waitlist period. We know that many people who use our programs are using them in tandem with other supports. There’ll be people where it’s going to be sufficient on its own, and others where it's going to be part of a package of care. It can make delivery of treatment much more effective and efficient.
Is there an alternative treatment plan besides digital mental health?
Yes, digital mental health is not the only way to get there. For example, we’re also learning about non-specialist providers in which an individual can get the help they need without seeing someone, like me, who has a PhD. As a resource, psychologists are costly. There’s really exciting external research that’s happening in this area. We know that mental health counselors with a really specific training-focus can be quite effective even though they don’t have the equivalent education of a PhD. This is really exciting global work that prompts us to think about other models of delivering care that are really innovative and can make big changes to people’s mental health care support.
Did you always know that you wanted to go into academia? If so, what parts about academia specifically interested you?
I didn’t always know. It wasn’t until later in college that I began to become more interested in research and realized “this is really cool”. The first thing that really drew me to academia was the fact that I get paid to think about questions that I find fascinating and then figure out good ways to answer those questions. That part felt like a really amazing opportunity. As an academic, I love the variety that I get to have. I love that I get to work with amazing students, undergraduates, and graduate students on the research side. I like teaching and doing clinical work. As the Director of Clinical Training, I really enjoy running a training program so that I am able to train the next generation of therapists and clinical psychologists. I like that, on a given day, I will do 12 different things. I wouldn’t want to be doing only research, or only doing therapy, or only doing teaching, or only doing an administrative role. I really appreciate that academia gives me the freedom to build a combination of activities that are personally fulfilling and allow me to contribute in a wide variety of ways.
Have you seen “setting up and running your own lab” as one of the biggest challenges for you?
It wasn’t setting up a lab that I found particularly hard. I’ve had challenges managing various demands and ensuring that everyone gets feedback in a timely manner. In my lab, we do a lot of projects at the same time. I collaborate with a lot of people, which is one of the things I love so much about the job, but this also requires a lot of demands that are ultimately up to me to fulfill. The time management piece really is the most challenging. Another piece that’s been really challenging is trying to be able to do the technical parts of the work when we don’t have enough resources to support it. It's very expensive and very time consuming to have an app developed. I’m grateful to work with an amazing team of engineers and computer scientists, but sometimes we’re trying to do too much with too little and that can be really tough. I’d say the resource and time-management piece of it all has been the most challenging thing for me.
What is your favorite part about having your own lab?
My favorite part is getting to work with an amazing group of students who are inspiring, interesting, and fun. I love team science. I like that we have a big team and get to share ideas. I think much better when ideas are circulating than when I’m just sitting on my own thinking about things. I love the team science part of it and working with amazing students.
What is your least favorite part about having your own lab?
The part I like least is when I have to be tougher on someone who’s not meeting deadlines or following through with certain tasks. Those types of things that’s not fun at all. Luckily, I don’t have to do too much of that because I work with amazing students, both undergraduate and graduate, who are very motivated. The late-night deadlines trying to finish things up are not always the most fun either.
You've been continuously funded by the National Institutes of Health and private foundations. How do you navigate the competitive landscape of securing research funding?
Recognize that there’s some randomness and craziness in the system, so you just need to apply and go for it. Someone once told me: “It’s like throwing spaghetti against the wall and you see what sticks.” I don’t think it’s quite that random, but I now understand where they were coming from.
Have you learned any tips or tricks for this process you could share for people hoping to receive a grant?
There are ways to be more strategic that I’ve learned over time. For example, talking to program officers can be really helpful. Now, before I submit a grant, I will almost always talk with someone at the granting agency about the idea in advance. This helps me get feedback about ways to modify that idea to fit what the granting agency cares about and what their priorities are. Then, try to imagine what reviewers might be concerned about and how we might address those concerns in advance. Now, I’m much more strategic in those ways and have a much better hit rate for grants as a result.
What advice would you offer to early career research in this regard?
A big part of it is just having thick skin and realizing that there’s lots of reason that you might not get a grant. It doesn’t mean it was a bad idea or that you’re not a good researcher. Many of the grants we apply for have a 90% rejection rate. Of course we’re rejected a lot. Loads of good ideas are rejected. The only thing that you can do is just to keep a thick skin and get back up.
How do you deal with rejection and how does it affect your research?
You’re allowed to feel bruised for a little while, but always get back up. It’s never wasted time, you can always use some of those ideas and writing. It’s all about getting back up and trying again. Personally, I find that thinking about the reason for proposing the grant in the first place can be really motivating. I become excited at the sheer thought of being able to carry out the work, have the resources, and asking specific questions in an effective and novel way.
What advice would you give to someone about pitching their research ideas?
My advice would be to ensure that you’re truly excited about the ideas so that you can then communicate that excitement and the value of these ideas to others. If you believe in the product you’re selling, then the sales pitch isn’t so bad. By the end of a grant time, you’re usually tired, but also hopeful. I try not to write a grant unless I truly feel compelled to carry out and study that work. I don’t look at grants as the ultimate “next step”. They’re too time consuming and too much work to do unless you really feel that passion about the work.
What moments or achievements stand out to you as particularly meaningful in your career thus far?
There are many. I cherish moments when I see a student that I’ve mentored give their first talk at a conference or get a new position/grant. That’s been incredibly rewarding for me. I'm also really spoiled to work with such a great group of people where we not only do good science, but also have a ton of fun together. We do an annual dinner every year at our big annual conference, Association for Behavioral and Cognitive Therapies (ABCT). Last year, we had 17 alum from the lab and current students attend. Those moments are always very meaningful times for me that I would highlight.
What direction do you see your research moving towards in the next five years? What do you hope to see?
I'm really excited to make progress on just-in-time adapted interventions in the future. This will involve bringing together a few different lines of our work so that they can function in an integrative way. We try to sense when people need help and then take note about things in their context to advise us on what kind of help would be most effective. All of the intervention development work that we do is also important. I’m very interested in trying to personalize these interventions much more than we currently do so that we can better match the recommended intervention for a person to their particular context and to things about them as an individual. When we can do that more effectively, this will help address some of the challenges that I've highlighted, such as the difficulties with engagement. Being able to truly make progress in the just-in-time adapted interventions will take us a long way as a field and allow us to realize the potential of these programs. I’m excited to add personalization so that we can help people when and where they need it the most in a way that really matches their particular need.
Did you have a specific mentor that really shaped your career or interests or type of work that you do now that you would hope to be for others in the future?
I've been really lucky to be mentored by some really amazing people. To name a few, Dr. Sheila Woody who was my graduate advisor, Dr. Jack Rachman who was my undergraduate advisor, and Roz Shafran who was a really great mentor prior to graduate school. I’m also really grateful to be married to another psychological scientist. He’s fun to talk to about ideas and he can also be a big help with stats! He’s really pushed me to go more on the Open Sciences Best Practices, which I believe in strongly, and I believe it has improved our work a lot. Although he’s certainly not a mentor, as he’s my partner, he's been a wonderful influence. We’ve been together 25 years and he’s been a big influence in shaping what I do and who I am as a scientist.
Outside of science and research interests, what do you enjoy doing day to day? What motivates you outside of research?
I'm a mom with 2 teenage daughters and 2 dogs, so spending time with my family is definitely top of the list. In regards to hobbies, I love to read, dance, enjoy theater, and spend time outdoors. I also love to travel, both professionally and within my family. Discovering new places is something I love to do. Every 2 years, my mom and I have gone on an exotic trip together where we explore somewhere different and interesting. So far, we’ve gone to China, Peru, India, Vietnam, and Morocco!
