Bio

Clinical Focus


  • Dialectical Behavior Therapy
  • Mindfulness
  • Acceptance and Commitment Therapy
  • Trauma
  • Emotion Regulation
  • Adolescents
  • Personality Development
  • Psychology

Academic Appointments


Administrative Appointments


  • Director, Stanford DBT, Stanford University Medical Center (2011 - Present)
  • Clinical Director, Early Life Stress and Pediatric Anxiety Program, Stanford Children's (2012 - 2015)
  • Assistant Clinical Director, Child Psychiatry Outpatient Services, Stanford Children's (2013 - Present)

Professional Education


  • PhD Training:Penn State College of Medicine (2008) PA
  • Fellowship:Stanford University School of Medicine (2010) CA
  • Internship:Beth Israel Medical Center - New York (2008) NY

Research & Scholarship

Current Research and Scholarly Interests


Dr. Zack is involved with ongoing research related to the treatment of adolescent and adult trauma (Trauma Focused Cognitive Behavioral Therapy - TF-CBT; Prolonged Exposure - PE), and the effective provision of Dialectical Behavior Therapy (DBT) to adolescent girls and women with disorder of emotion regulation. She additionally studies Acceptance and Commitment Therapy (ACT) for adolescent girls with anxiety. More broadly she is interested in the impact of Evidenced Based Treatments on improving quality of life, and helping individuals find the right match for clinical care. Research is conducted through the Early Life Stress and Pediatric Anxiety Disorders Program at Stanford Children's Hospital and the Stanford Dialectical Behavior Therapy Program.

Teaching

Graduate and Fellowship Programs


Publications

All Publications


  • Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder. Science translational medicine Etkin, A., Maron-Katz, A., Wu, W., Fonzo, G. A., Huemer, J., Vertes, P. E., Patenaude, B., Richiardi, J., Goodkind, M. S., Keller, C. J., Ramos-Cejudo, J., Zaiko, Y. V., Peng, K. K., Shpigel, E., Longwell, P., Toll, R. T., Thompson, A., Zack, S., Gonzalez, B., Edelstein, R., Chen, J., Akingbade, I., Weiss, E., Hart, R., Mann, S., Durkin, K., Baete, S. H., Boada, F. E., Genfi, A., Autea, J., Newman, J., Oathes, D. J., Lindley, S. E., Abu-Amara, D., Arnow, B. A., Crossley, N., Hallmayer, J., Fossati, S., Rothbaum, B. O., Marmar, C. R., Bullmore, E. T., O'Hara, R. 2019; 11 (486)

    Abstract

    A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.

    View details for PubMedID 30944165

  • PTSD Psychotherapy Outcome Predicted by Brain Activation During Emotional Reactivity and Regulation AMERICAN JOURNAL OF PSYCHIATRY Fonzo, G. A., Goodkind, M. S., Oathes, D. J., Zaiko, Y. V., Harvey, M., Peng, K. K., Weiss, M., Thompson, A. L., Zack, S. E., Lindley, S. E., Arnow, B. A., Jo, B., Gross, J. J., Rothbaum, B. O., Etkin, A. 2017; 174 (12): 1163–74
  • Selective Effects of Psychotherapy on Frontopolar Cortical Function in PTSD AMERICAN JOURNAL OF PSYCHIATRY Fonzo, G. A., Goodkind, M. S., Oathes, D. J., Zaiko, Y. V., Harvey, M., Peng, K. K., Weiss, M., Thompson, A. L., Zack, S. E., Mills-Finnerty, C. E., Rosenberg, B. M., Edelstein, R., Wright, R. N., Kole, C. A., Lindley, S. E., Arnow, B. A., Jo, B., Gross, J. J., Rothbaum, B. O., Etkin, A. 2017; 174 (12): 1175–84
  • Reorganization of Resting Connectivity Patterns Following Psychotherapy for Posttraumatic Stress Disorder Fonzo, G., Goodkind, M., Oathes, D., Zaiko, Y., Harvey, M., Peng, K., Weiss, E., Thompson, A., Zack, S., Mills-Finnerty, C., Rosenberg, B., Edelstein, R., Wright, R., Kole, C., Rothbaum, B., Etkin, A. NATURE PUBLISHING GROUP. 2017: S122–S123
  • The Effects of Psychotherapy on Amygdalar Subregional Functional Connectivity in PTSD Fonzo, G., Goodkind, M., Oathes, D., Zaiko, Y., Harvey, M., Peng, K., Weiss, E., Thompson, A., Zack, S., Mills-Finnerty, C., Rosenberg, B., Edelstein, R., Wright, R., Kole, C., Rothbaum, B., Etkin, A. ELSEVIER SCIENCE INC. 2017: S236–S237
  • Brain Mechanisms and Predictors of Response to Prolonged Exposure Therapy in PTSD Fonzo, G., Goodkind, M., Oathes, D., Zaiko, Y., Harvey, M., Peng, K., Weiss, E., Mills-Finnerty, C., Thompson, A., Zack, S., Lindley, S., Arnow, B., Jo, B., Gross, J., Rothbaum, B., Etkin, A. NATURE PUBLISHING GROUP. 2016: S291–S292
  • Attachment History as a Moderator of the Alliance Outcome Relationship in Adolescents PSYCHOTHERAPY Zack, S. E., Castonguay, L. G., Boswell, J. F., Mcaleavey, A. A., Adelman, R., Kraus, D. R., Pate, G. A. 2015; 52 (2): 258-267

    Abstract

    The role of the alliance in predicting treatment outcome is robust and long established. However, much less attention has been paid to mechanisms of change, including moderators, particularly for youth. This study examined the moderating role of pretreatment adolescent-caregiver attachment and its impact on the working alliance-treatment outcome relationship. One hundred adolescents and young adults with primary substance dependence disorders were treated at a residential facility, with a cognitive-behavioral emphasis. The working alliance and clinical symptoms were measured at regular intervals throughout treatment. A moderator hypothesis was tested using a path analytic approach. Findings suggested that attachment to the primary caregiver moderated the impact of the working alliance on treatment outcome, such that for youth with the poorest attachment history, working alliance had a stronger relationship with outcome. Conversely, for those with the strongest attachment histories, alliance was not a significant predictor of symptom reduction. This finding may help elucidate alliance-related mechanisms of change, lending support for theories of corrective emotional experience as one function of the working alliance in youth psychotherapy.

    View details for DOI 10.1037/a0037727

    View details for Web of Science ID 000354606900016

    View details for PubMedID 25822108

  • Mindfulness Based Interventions for Youth JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY Zack, S., Saekow, J., Kelly, M., Radke, A. 2014; 32 (1): 44-56
  • HELPFUL AND HINDERING EVENTS IN PSYCHOTHERAPY: A PRACTICE RESEARCH NETWORK STUDY PSYCHOTHERAPY Castonguay, L. G., Boswell, J. F., Zack, S. E., Baker, S., Boutselis, M. A., Chiswick, N. R., Damer, D. D., Hemmelstein, N. A., Jackson, J. S., Morford, M., Ragusea, S. A., Roper, J. G., Spayd, C., Weiszer, T., Borkovec, T. D., Holtforth, M. G. 2010; 47 (3): 327-344

    Abstract

    This paper presents the findings of a psychotherapy process study conducted within the Pennsylvania Psychological Association Practice Research Network (PPA-PRN). The investigation was the product of a long-term collaborative effort, both in terms of the study design and implementation, between experienced clinicians of various theoretical orientations and full-time psychotherapy researchers. Based on a relatively large sample of clients seen in independent practice settings, close to 1,500 therapeutic events (described by clients and therapists as being particularly helpful or hindering) were collected. These events were coded by three independent observers using a therapy content analysis system. Among the findings, both clients and therapists perceived the fostering of self-awareness as being particularly helpful. The results also point to the importance of paying careful attention to the therapeutic alliance and other significant interpersonal relationships. The merits and difficulties of conducting scientifically rigorous and clinically relevant studies in naturalistic contexts are also discussed.

    View details for DOI 10.1037/a0021164

    View details for Web of Science ID 000282850000007

    View details for PubMedID 22402090