A brain-based approach to understanding and treating mental illness and suicide prevention
Emotions and mental functioning are influenced by a network of interconnected structures in the brain that make up what is known as the limbic system. They play a powerful role in tuning our perception, informing our experience, guiding our decisions and shaping our actions. How they contribute to anxiety, fear, depression, addiction, post-traumatic stress disorder (PTSD), obsessions and compulsions can be understood along dimensions of brain circuit function as it relates to emotion, motivation and affects regulation.
Using neuroscience measures and methods to study the emotional brain and how it evolves over a lifespan and fluctuates with stress, researchers at The Ohio State University College of Medicine and The Ohio State University Wexner Medical Center combine readouts in the laboratory with psychopharmacology, neuromodulation and intervention trials to assess and improve brain circuit function.
Through an increased understanding of the disordered physiological processes inherent in nervous systems with abnormal mental states, they can innovate strategies to prevent the progression of mental illness and treat more patients better and faster and keep them well for longer periods of time.
K. Luan Phan has a longstanding commitment to translate discoveries from affective and cognitive neuroscience and neuropsychopharmacology to improve the understanding and treatment of anxiety and mood disorders. He has expertise in traumatic stress, anxiety and addiction.
Craig Bryan is a board-certified clinical psychologist with expertise in cognitive-behavioral treatments for individuals experiencing suicidal thoughts and PTSD. As a military veteran (he deployed to Iraq in 2009), he has expertise working with military personnel, veterans and first responders.
Ken Yeager is the director of the Stress, Trauma and Resilience (STAR) Program at The Ohio State University Department of Psychiatry and Behavioral Health. His work focuses on three areas: support for professionals, support for survivors and leading-edge research on the impact of stress and trauma.
How has functional magnetic resonance imaging (fMRI) transformed psychiatric and behavioral health research?
K. Luan Phan: It established that psychiatric disorders are, in fact, disorders of the brain and that diseases with similar clinical profiles can be differentiated on a neural (nervous system) level. We use fMRI to examine and measure the electrical activity of brain cells, chemical activity and flow in the brain in real-time and to assay differences in properties and function in brain systems. It illuminates how a brain in a state of disorder functions differently from a normal one.
How is brain imaging influencing the diagnosis and treatment of mental illness?
KLP: We can now measure and differentiate activity in the brain much like how cardiologists measure heart function and heart attack risk through blood pressure. Then we can prescribe medication, for instance, ones proven to reduce high activity in the amygdala, along with therapy and other interventions, much like how doctors provide medication to lower blood pressure.
How do patients and practitioners react when you show them the differences between a brain that is able to bounce back from adversity and stress and one that isn’t?
KLP: They are shocked and relieved. It establishes a biological source which also reduces stigma and I think it makes them feel better. They can see how changes in their brains contribute to symptoms and behaviors.
How do stress, trauma and adversity affect the brain?
KLP: Stress and trauma not only change our cognitive and psychological perspective but also our biology in terms of changes to the brain. Stress activates the “fight or flight” survival system and increases stress hormones and chemicals. The amygdala, hippocampus and prefrontal cortex are areas in the brain that are implicated in the stress response. High activity in the amygdala, much like high blood pressure, shows increased activity in brain scans, which is also characteristic of depression and other mental health diagnoses.
What are the common physical and emotional responses people have to a traumatic event or trauma caused by violence?
Ken Yeager: They can include hypervigilance, or feeling on edge, avoiding triggers related to the trauma, trying to maintain control of people or situations around you, not knowing who or what to trust, and difficulty knowing who you can safely share your thoughts and emotions with. Trauma can have lasting adverse effects on a person’s functioning and on his or her mental, physical, social, emotional or spiritual well-being.
How does the Stress, Trauma and Resilience (STAR) Program help people overcome trauma?
KY: We focus on three areas: support for professionals, support for survivors and leading-edge research on the impact of stress and trauma. Our program has trained close to 900 people to do peer support for their colleagues in the form of brief emotional support teams. This support is a framework of some psychological first aid, a bit of cognitive reframing and motivational interviewing stitched together. Over the past 10 years, this program has helped create a common framework and language for addressing the impact of traumatic stress, vicarious trauma and moral distress.
We provide survivors comprehensive psychiatric care and case and medication management. We understand survivor needs, both immediately following an incident and longterm. We use standardized assessments based on research to deliver evidence-based treatment with compassion and respect for each person. Because each trauma experience is unique, treatment is tailored to the individual.
What is the long-term outcome for people who experience trauma?
KY: People usually follow one of three paths: a life shaped by PTSD, a gradual return to pre-trauma life or one changed by post-traumatic growth. Helping people achieve the latter is something I have tried do over the course of a 30-year career studying trauma and working with traumatized individuals.
Suicide rates continue to climb in the U.S. despite an increase in mental health awareness and availability of treatment. What are we getting wrong about suicide prevention?
Craig Bryan: We don’t appreciate how factors besides mental illness influence a person’s decision to try to end their life. Factors like personal decision-making styles, level of intensity in reaction to life stressors, lack of impulse control or the availability of lethal means, like firearms, all play a part in suicide.
What have you learned from survivors of suicide attempts that supports your assertion that there's more to suicide than underlying mental health conditions?
CB: Reports from survivors allowed us to gauge how much time passed between their thinking of suicide and their attempt. One quarter of them reported the time frame was five minutes or less. People need effective intervention before everything builds up to the point that they think ending their lives is the best way to end the emotional pain and pressure.
Our program has trained close to 900 people to do peer support for their colleagues in the form of brief emotional support teams.”
Ken Yeager, PhD