By Blake Belden

For most people, chasing a dream of becoming an actress doesn’t usually lead down a path toward a career developing cognitive rehabilitation interventions to improve the neurocognitive and emotional well-being of brain cancer patients.

But for Sarah Braun, Ph.D., LCP, a member of the Cancer Prevention and Control research program at VCU Massey Comprehensive Cancer Center, that is exactly how her story played out.

And now, years later, her passion is powered by her commitment to her patients, whose diagnoses are accompanied by a number of functional and cognitive setbacks in addition to their cancer treatment.

“That’s a traumatic experience, and I want to help my patients get to a place where they feel self-efficacy and they feel capable in their daily lives, but also to a place where they know how to give themselves grace,” shared Braun, who is also an assistant professor of neurology at the VCU School of Medicine and a clinical neuropsychologist at VCU Health.

After growing up in Lexington, Kentucky, Braun relocated to Chicago to pursue a degree in fine arts. She dropped out of theater school a couple years later, with the notion that she would move to Los Angeles to catch her big break. Instead, Braun ended up in San Diego, working in the restaurant industry as a server and bartender.

But life had other plans for her and Braun decided she wanted to go back to school. She was drawn to the concepts of meditation and tai chi — contemplative wellness practices she was introduced to during theater school.

She soon learned there was a professor back in her hometown at the University of Kentucky — Ruth Baer, Ph.D. — who was an expert in mindfulness and the scientific study of behavioral interventions.

“I was very intrigued because I knew I wanted to learn more about that, and I knew I wanted to be a psychologist,” said Braun, who completed her undergraduate degree in psychology at her hometown university in 2012.

In 2014, Braun entered the clinical psychology Ph.D. program at Virginia Commonwealth University’s College of Humanities and Sciences, and soon became intrigued by the intersection of mindfulness, psychology, and neurosciences. After listening to a compelling talk from Ashlee Loughan, Ph.D., a neuropsychologist and member of the Cancer Prevention and Control research program at Massey, Braun began a clinical practicum – a formal opportunity to shadow a medical professional or research – with her in 2016. Since then, Braun has been working with brain tumor patients in some capacity.

Braun is now a co-assistant director of the LiveNOW Lab, an initiative launched by Loughan at VCU to advance research focused on neuro-oncology wellness by learning more about the psychological, social, and cognitive needs of patients affected by brain cancer. Braun has been involved with LiveNOW since its inception in 2017 and was recruited to steer the neurocognitive wellness efforts of the lab.

Earlier this year, Braun received funding through Massey’s American Cancer Society Institutional Research Grants and VCU’s QUEST Fund to finalize the manual for and test the feasibility of the cognitive rehabilitation intervention that she developed known as Cognitive Strategies Mindfulness and Rehabilitation Therapy (C-SMART).

C-SMART is tailored to patients with primary brain tumors and cognitive deficits. Developed from expert and community member input, C-SMART is a 1:1 telehealth intervention delivered over eight weekly 60-minute sessions. It includes neurocognitive feedback on identified strengths and weaknesses; collaborative goal setting to address the patient’s desire for change; strategy learning and practice to meet functional goals; and integrated mindfulness training. C-SMART includes caregiver participation to optimize strategy integration at home and in daily life.

Evidence-based, personalized interventions are currently used effectively in patients with serious brain injuries, strokes, or other neurological diseases. However, little has been developed for patients with brain tumors. Braun said this is because the patient population is significantly diverse, based on factors like tumor location, disease stage, treatment type, side effects, among many others.

“All of these things make the science difficult, especially if we’re tailoring therapy to patients’ specific weaknesses,” Braun said. “C-SMART integrates cognitive rehabilitative therapy and mindfulness practices individualized to each patient to improve neurocognitive functioning and, essentially, independence in their day-to-day lives.”

Her newly awarded grant funding will support a feasibility and acceptability study of C-SMART that investigates brain scans, or functional neuroimaging, as a potential outcome from pre- to post-C-SMART, as well as to identify necessary protocols for processing and interpreting the data from these scans for future studies.

“With general cognitive rehab, it’s only going to move the needle so much for these patients. But if we offer them something that is specific to them and really speaks to them like C-SMART, then that is what will change their everyday life,” Braun said. “That’s what is going to matter to them so they can feel validated and have tools to handle cognitive slips and to handle what the disease has done to them.”

Braun and Loughan also recently were awarded funding through the National Cancer Institute to investigate a behavioral intervention to reduce the fear of disease recurrence among brain cancer patients and their caregivers.