From Surviving to Thriving: Carla Chugani

Carla:  I had to kind of remind myself that you've got to radically accept that you can be the most well organized and motivated PI and you can't control what happens in your study and problems will always happen and that's normal and that’s par for the course and you can't freak out about it every single time because you're not going to make it. 

 
Mike: From CTSI, this is the Products of Pittsburgh. A show about the people in Pittsburgh – innovators, scientists, community leaders – and the remarkable stories behind how they came to be and the work they’ve produced.  I’m Mike Flock.  On the show today, Bee Schindler and I catch up with Dr. Carla Chugani, Assistant Professor in Pediatrics at the University of Pittsburgh.   
 

Mike: In 2016, Carla arrived at the University of Pittsburgh as a postdoctoral scholar.  As the daughter of academic parents, it’s no surprise that Carla decided to pursue a similar path.   Today, as an assistant professor, Carla is conducting research, teaching, and developing programs focused on mental health and suicide prevention.   Carla was born in Los Angeles to parents who were both neuroscientists in faculty positions at UCLA.  She was 9 years old, and her younger brother had just been born, when the family packed up and moved to Detroit so that her parents could start the first PET center for pediatrics in the country.  PET as in Positron Emission Tomography - an imaging technique used to observe metabolic processes in the body and brain.  Carla wasn’t initially interested in science or even mental health for that matter despite her early influences.  Carla first wanted to pursue a career in music.  And not just any music, opera.     

Carla: When I was a kid I was always really interested in music and I think that started really young because my dad is a pediatric neurologist and so he really encouraged me to learn to play an instrument.  I think he was hoping that it would make me smarter, but it ended up making me more musical.  I always wanted to sing and so I took a lot of voice lessons.  I actually have a Bachelors in Opera performance.  
 

Bee:  So you did end up studying Opera I'm sure there's a more official path for that how did that end up being the major that you landed on? 

Carla:  Well so I started taking voice lessons when I was in middle school and got really serious about it in high school.  I was studying with a college professor when I was in high school.  So she kind of prepared me for auditions and stuff like that and when I was in high school, I didn't really have the sense that I was smart.  I think that I felt like I should study voice because that was what I was good at and so if I was going to be able to make a living doing something that it would be voice.  Probably a 15 year old me would have had like a much more passionate answer about the music.  

Mike:  What did your parents think? Being neuroscientists and their daughter now performing and singing.     

Carla:  They were super supportive. I think that they did want me to go to a regular university. I went to conservatories.  My bachelor's degree is a Bachelor's of Music it's not like a Bachelor of Arts or Bachelor of Science or something like that that's a little bit more transferable.  That was sort of the one thing that I do remember them kind of being like oh no would you consider and of course I wouldn't.  In retrospect, when people ask me about this I always say you know that's the one thing I wish I had done is you know not that my education was bad by any means but that if I could do it over again it would have been cool to have something a little bit more well-rounded because then maybe I wouldn't have struggled so much in graduate school if I had taken a math class you know any time since high school. 

Mike: So how did you transition, because you went from opera performance to studying mental health counseling?  How did you decide to change that focus?   

Carla:  I had really severe mental health problems when I was in college and basically by the time I graduated I was just done with music, done with trying to make it work. So what happened is I kind of I went home and I had this space for the first time ever I think where I could just focus on figuring stuff out.  During that time I met this really great guy who's now my ex-husband, still a really great guy, and we ended up moving down to Florida.  I really had no idea what I was going to do in Florida.  My mom suggested that I do volunteer work and so I started doing volunteer work for a shelter for abused women and children.  I was volunteering and then they hired me and so I would work with these families and I just really wanted to be able to help them in a way that I didn't have the skills to do.  I remember calling my therapist and sort of asking like you know is this crazy like would it be crazy for me to go to grad school and become a therapist and she was like no I think you'll be great at it and I was okay, alright.  So I got my master’s degree and became a counselor and had just this incredible experience.  I was not even committed to it at first, right.  I signed up as a non-degree-seeking student because I really thought like I don't even know if I can handle graduate work. I mean I can barely get through my undergrad and I remember being in the first class of my master's program with this really fabulous Professor Maddie Isaacs and I was just hooked and I just remember being like this is it, this is what I'm going to do now and I did. 

Carla: I was really lucky so there was one paid internship in that program and it was in the counseling center at the University and I got one of those spots.  That is how I got into collegiate mental health which in retrospect given some of the experiences that I had you know made a lot of sense for me and felt very personally fulfilling as well. 

Bee:  Yeah, I was thinking even just moving through some of the educational space did that feel healing to you?  

Carla:  When I was in grad school that was the first time I ever had to think about hiding my history because it's Florida and it's hot, really hot in the summer down there and I have scars on my arms and so I would wear long sleeves.  When I would ask professors about it they be like yeah it's you know probably for the best if you're not super open about that.  So it did show up in that way and that there was kind of a struggle around how do I be authentically myself which is the most healing thing and also hide this huge thing that at that time I was not that far removed from and basically what I came to was that I can be myself without having to share every detail about my life all the time.  I think that the process of becoming a therapist, which was very different than the process of becoming a scientist, it did force me to confront some of my stuff. I had confronted a lot of it already by that point but it did make me more aware of certain things and it actually made me more open to certain things as well. When I was in college I had a lot of I suppose good treatment from really reputable providers because I come from a place of incredible privilege with parents who can navigate healthcare systems and find the types of treatment for the diagnoses that I had but I had a really bad experiences with DBT which is a type of therapy that I specialize in now and so I was very anti-DBT at that time and then once I was in grad school I became very interested in DBT because I was able to navigate the literature well enough to understand that this was really something special and something that had really been shown to be effective and efficacious for people like me.  

Mike:  Dialectical behavior therapy or DBT is a type of cognitive behavior therapy developed by psychologist Dr. Marsha Linehan and has been used for the treatment of chronically suicidal and self-injuring behavior and borderline personality disorder. The DBT approach was developed to help people who struggle with dysregulation in a variety of domains and broadly, the treatment helps patients learn skills to cope more effectively and develop better self-regulation, whether it’s regulating thoughts, emotions, behaviors, or interactions with others.  Carla began her DBT training in 2009 during an internship with the Counseling and Psychological Services at Florida Gulf Coast University.  She would go on to receive her Master’s in Mental Health Counseling, become a licensed therapist, and obtain a PhD in Counselor Education.   In 2016, Dr. Carla Chugani decided to join the University of Pittsburgh and became the first postdoctoral scholar to receive a position on Dr. Elizabeth Miller’s T32-funded Adolescent Research in the Community Training program. This experience, along with Dr. Miller’s mentorship, became a critical turning point in her career towards becoming a clinical scientist.   

Carla: So I didn't think I was going to get a job and so the agreement I had with my partner who lived in Pittsburgh is that if I did not get a tenure-track job then I would move to Pittsburgh and if I did get a tenure-track job then he would go with me.  I did get a tenure-track job offer, but before I got it I was convinced I wasn't going to get a job.  So I started just Googling like who in Pittsburgh does DBT research and I come across Tina Goldstein who's just phenomenal and of course I didn't know who she was at the time.  I email her and I basically send her my CV and asked if I could be her research assistant or something like that because I just really wanted to stay connected with research and she was like well why don't you be my postdoc and I was like okay.  So then I had a choice of this teaching heavy tenure-track job or a T32 funded postdoc and I decided that I would just go for it and do the T32 and that's how I ended up here.  

Carla:  I do see patients one day a week and that's very important to me because I think as a clinical scientist if you're not doing the clinical part it's easy to become detached from the reality of what it looks like to be the boots on the ground and that's really important for me because I'm very interested in intervention development.  So the research that I do is something that I've wanted to do actually since I was working on my master's degree.  So back at that time I started a DBT program in the college counseling center and DBT is a complicated treatment and there's individual therapy and there's group skills training and we do phone coaching in between sessions and then there's a therapist consultation team meeting that happens every week.  There's a lot of different parts to the treatment, but one of the parts is skills training and that is where we teach people skills related to mindfulness, distress tolerance, which is basically like don't make it worse, and interpersonal effectiveness and emotion regulation. I'm teaching these skills in this group of chronically and highly suicidal college students, but I thought I always thought that the skills are skills for everyone and wouldn't it be great if we were teaching these in schools and this was part of health education and so to use this is very potent and very effective treatment as prevention.  I had the idea basically 10 years ago now and was told that it would not happen and that idea is actually part of the reason I got my Ph.D. to be able to do that research.  So what would it look like if we translated these really effective and potent evidence-based treatments for suicide into prevention and put it in the educational environment.  

Bee:  Yea, that’s awesome 

 
Carla: Yeah, I have two studies going on related to that right now.  One is at the college level.  My really good friend Jim Mazza from University of Washington, which is where Marsha Linehan worked too, developed this course called Wellness and Resilience for College and Beyond.  It's basically DBT skills as a 3-credit undergraduate college course.  The therapeutic part is taken out and replaced with more like the homework assignments are very self-reflective and that's that piece that normally you would do with your therapist.  I teach a section here at Pitt.  We actually have two sections now because it's been so popular and then we're also on four other local campuses.  So it's a multi-site trial with five campuses involved.  
 

Mike:  It sounds like even though you’re still getting your feet wet in academics you’re off and running in terms of funding?  

 
Carla.  Indeed 
 

Mike:  Which is great.  That’s always a big challenge. 

Carla: Yeah I've been really really lucky.  I have to say so part of what's really helped is I'm super fortunate to be connected to an organization called Embrace Pittsburgh and they have actually supported my multi-site trial.  Embrace Pittsburgh is an organization that is super interested in teaching DBT skills to the whole city of Pittsburgh. I thought I had big dreams and they just like blew it up ten times a hundred times bigger, like no we're doing it for the whole city and so they've got a bunch of really cool initiatives.  They fund research like mine.  They fund programs like Active Minds and Jed Campus to work with Pittsburgh campuses and then they do a lot of really cool activations and events around the city.  They have partnerships with the Steelers and the Penguins and the Pirates.  I actually got to go to a Pirates game recently for their break the ice event which is all about starting conversation about mental health.   I'm incredibly fortunate to be their partner and if anyone's interested in learning more about that follow them on social media, their posts are incredible.  

Mike: In January 2019, Carla started her position as an Assistant Professor at the University of Pittsburgh in the Department of Pediatrics, specifically the Division of Adolescent and Young Adult Medicine.  Within a few months, she won a funding award through CTSI’s Pain Research Challenge to pilot a DBT skills training curriculum designed to be delivered in middle schools and high schools called DBT Skills Training for Emotional Problem Solving for Adolescents, or DBT STEPS-A.  And around that same time, received funding through the WORDOUT: Community Research Dissemination Challenge to organize an event where members of the LGBTQ community come together to discuss mental health topics with researchers and ways to work together.  Carla is clearly well on her way to becoming a leader in mental health research.  However, in the relentless world of grants and publications, being an early career researcher at a major academic institution like Pitt can feel a bit daunting.   Young investigators are often still learning a lot of necessary skills such as budgeting, grant-writing, and even managing personnel.   To handle this pressure, Carla is practicing one of the very skills that she teaches – radical acceptance   

Carla:  I'm super fortunate that the mental health stuff that I had I recovered from and so it's amazing to not live with mental illness, but there is there are biological elements of that that I don't think will ever go away like temperamentally I have really extreme emotional sensitivity and then it takes me a long time to come back down to baseline. I think that's just like part of my temperament and so when I react the big thing for me is to bring myself back to this place of like no matter how strongly I'm reacting and no matter how high the urge is to try and rush in and solve this problem I can’t actually change what's going on in this moment. So radical acceptance doesn't mean that you approve of something.  It doesn't mean that you will like something. It just means that in this moment you accept that this is reality. There's a lot of things like that you know it's funny because this is just the very beginning of my second year on the faculty at Pitt and I didn't realize how lumpy the transition could be into a faculty job. I thought I was prepared and I was prepared and also there were a lot of new occasions to rise to and so one of the things that I would worry a lot about, especially with the two studies that I was talking about earlier, it's like you know what if I mess it up or if the data collection isn't going according to plan or something happens unanticipated events that you know all those kinds of things and it was really causing me a lot of stress.  I had to kind of remind myself that you've got to radically accept that you can be the most well organized and motivated PI and you can't control what happens in your study and problems will always happen and that's normal and that’s par for the course and you can't freak out about it every single time because you're not going to make it. 

Bee:  There was a Pittwire article about an interview to you and you were saying that you really want folks to not just survive that you know you want to thrive  

Carla:  Yeah  

 
Bee:  What does thriving mean to you currently in your life where you sit? 

Carla:  To me, I think it means having a life outside of work.  If I just have that I'm winning.   And I have that.  I work really hard and sometimes really really long hours as I think every everyone does, but I have also learned that I need to practice what I preach a little bit more in terms of maintaining limits around some of that.  So that I can have a life. So that I have energy to be with the people in my life fully you know be present to the people in my life and do fun stuff and be willing to take vacations even if it's not totally lined up with the NIH Grant cycles.  You can’t wait for things to ease up to do the things that you want to do because it will never ease up. I feel like at the end of my first-year coming into my second year I've actually figured that out now. And I've had really really good mentorship here at Pitt not only from Tina but from Liz Miller and Shaun Eck as well.  It's the trifecta of the most amazing mentors you could ever ask for and so I do feel like because of how conscientious they've been with me about helping me develop myself in the ways that I wanted to develop but also may be needed to develop that one day maybe not exactly now but not too long from now I probably will have some good stuff to offer the next generation of scientists.  I love the research that I do of course and I love working with the with the students and the wellness course and I'm definitely not going to stop until I get an R01 to do a randomized controlled trial. It's going to be great  

Mike: An R01 is a research project grant mechanism offered by the National Institutes of Health and considered to be one of the most coveted grants because of the amount of funding as well as its exclusivity.  Receiving an R01 is a major milestone for any biomedical research career.  It’s also a big step towards promotion and tenure for which generating research support is one important criteria.  Each school has their own guidelines, but in general, research, teaching, and other scholarly activities are key factors determining whether someone should advance from an assistant to an associate professor to a full professor.   Leadership, mentorship, professional service, as well as entrepreneurial activities are also being acknowledged by many schools because, as an academic, one can have a positive impact on the institution as well as the community in a variety of ways. Carla is creating her own path and making an impact already.  Even if there are a few pit stops along the way …  

 
Mike: Is there something in particular that you do or things you enjoy outside of work? 

 
Carla: So it's a little weird but so my husband Patrick he's an appraiser and his background is in fine art and antiquities and so when we met and I went to his apartment for the first time and it was filled with all these really weird old sometimes broken things and so it turns out that what he would do for fun is that he would go to the thrift store and find sort of these old things that you know they don't make any more, things that were valuable, or pieces of original art that people had just thrown away or donated.  So he started teaching me because basically when you're an appraiser you know something about everything. It’s unnerving. So he started teaching me first about pottery and then about like lithographs and etchings. I'm still not really great with paintings.  We go to thrift stores and find stuff that is actually in some cases really valuable.  Sometimes it's just really cool and you know becomes like a nice decorative piece in our house and one thing that I love about that, our house is just full of stuff that we from time that we spent together.  It's not just like stuff we bought off the shelf at the department store, it's all like a fun day that we went out and spent together, but we have also found some really cool stuff so we do have a Dali and a Matisse etchings.  

Bee:  Oh wow.  

Mike:  How did you come across those, hopefully not in a thrift store but perhaps? 

Carla: In the thrift store.  Yeah yeah  

 
Mike: If there's one word that you could select to describe yourself, what would that one word be? 

Carla:  Perseverance  

Mike:  That seems appropriate. 

Carla: A lot of people in academia talk about perseverance and especially you know when you're trying to get a grant right you have to write ten to get one.  So really the people who end up being successful are the people that keep trying and that is actually true across many professions. I find even when I think about the folks that I went to music school with I mean some of them were brilliant then and our brilliant now and are at the Cleveland Orchestra and all kinds of crazy places, most amazing places. More times than not the ones that are still working musicians and that are successful are the ones that worked really hard and that's kind of how I see myself is that I've never seen myself as a particularly smart person but I work really hard.  So perseverance  

Mike:  What do your parents think now seeing that you are in a faculty role at a major institution and them also being neuroscientists and faculty members themselves?  

Carla: I think they are proud of me and it's funny because I love to say I told you so that's like one of my absolute most favorite things to do.  I think I get this from my mother because she would tell me for years you know when I was agonizing about like well should I do a counselor ed or should I do clinical psych and will I be able to make it in academia and research if I'm in  counselor ed.  She would always say you know it really doesn't matter what your PhD is in it doesn't really matter what your background is, if you do good work people will notice.  I really didn't want her to be right about that but she totally was.  That is still one of her greatest i-told-you-so which she still brings up pretty frequently.  

Mike:  Do you sing at all, still do you ever have that opportunity or pursue it? 

Carla:  No, the stuff that I went through in college was just kind of traumatizing but also just the whole experience of being that unstable for that period of time it just kind of I don't know it brings up bad memories when I try to sing.  Singing when you've done it sort of in a professional way is different than when you've only ever done it as a hobby because the standard is different like you want to do it really at that level. So I have a hard time producing music for fun and then it does just also kind of bring up stuff that I feel like is better left in the past.  I did want to talk about some of that stuff with you guys because I feel like being a teacher now especially with undergrads I mean with graduate students as well obviously that it didn't feel appropriate for me to continue to pretend like I hadn't also gone through these things and I feel like it's important to be open in the way that I'm advocating for other people to be open.  I think there are a lot of people who are talking about their stories and even though there are a lot of people talking about their stories and their experiences with mental health I don't think it makes it less scary or any less of a risk for any one of us because stigma is still so pervasive.  I've been told that as a young investigator I'm vulnerable and that I should be careful about how I talk about some of these things.  I will own that is valid, right, being a young investigator is in some ways of vulnerable position to be in.  I just also think that like I'm a professor in a like really good medical school and that's a pretty profound position of privilege to be in relative to where I was before and the people who are in the position that I was once in and so I think that it's important to step up and sort of be like actually we do have something to contribute that's really valuable.  

Mike:  And a wise person once said, do good work people will notice.   

Carla:  I know right thanks for noticing you guys  

Mike: Carla Chugani, PhD, Licensed Professional Counselor, Assistant Professor in Pediatrics at the University of Pittsburgh.  Any by the way, Carla founded a local community group called South Hills United Against Hate which currently has 800 members!     
 

That’s our show.  Thank you for listening to the Products of Pittsburgh. Be sure to check out our website at ctsi.pitt.edu/podcast to hear more episodes as well as learn about CTSI programs and services.    I’m Mike Flock along with Bee Schindler and Zach Ferguson, until next time on the Products of Pittsburgh.