Strategic Initiatives: Neural Mediators of Psychotherapeutic Change
by Andrew Gerber, MD, PhD
In my own career, psychoanalytic research and clinical work have always gone hand in hand. I have long believed that by combining the enormous clinical sophistication of the psychoanalytic perspective with the careful precision and reproducibility of empirical research, we will be able to use research to improve patient care. I chose to come to Riggs because of the depth of its clinical work, and my appreciation for the staff, the patients, and the work they do together has only grown in the past year. That depth makes Riggs uniquely suited to participate in the design and execution of research studies aimed at increasing understanding of complex psychiatric disorders.
Over the past 100 years, neuroscientists have developed a basic understanding of the human brain’s biology, physiology, and structure, but there is also much that we do not know. At the same time, psychologists have refined our concept and definition of the mind and its capacities, but we still have much to learn about this as well. The greatest challenge, though, and one that requires our attention, is to understand how the mind arises from the biology of the brain. We have been limited in studying this by the difficulty of accurately measuring the structure and function of the brain in an awake person carrying out a behavior. One of the consequences of this limitation is that we do not yet understand the underlying pathophysiology of mental illnesses, and therefore have historically described them mostly with respect to symptoms, instead of underlying causes and mechanisms.
With the advent of new technologies over the past five-to-ten years, all of this is beginning to change more rapidly. Our Neural Mediators of Psychotherapeutic Change Strategic Initiative will use new neuroimaging hardware and software technologies to better understand both the brain and the mind in mental illness. A national research initiative called the Human Connectome Project (HCP) has assembled, and made available for research, a database from 1,200 healthy volunteers. The data include brain images and physiological recordings, and provide a body of information that constitutes a representation of the brain. HCP data may be compared to data collected from people with specific diagnoses to identify specific changes in the brain that may be associated with that mental illness, and may even be recognized in multiple individuals with the same diagnoses.
The National Institute of Mental Health (NIMH), which funds the HCP, is also supporting research to propose and test new measures of mental function. This is based on a conceptual model called the Research Domain Criteria (RDoc) matrix. The RDoC matrix proposes dimensional measures of mental function – like HCP, these include brain imaging and physiologic measures – and the NIMH is funding researchers to test and validate these proposed measures. The RDoC framework is compatible with both psychiatric thinking and contemporary neuroscience, and could bridge the two, offering a gateway to new insights into mental function and psychiatric illness.
Thanks to a major grant from philanthropists Bill and Deborah Ryan, our initiative will utilize magnetic resonance imaging (MRI) of the brain, a technique that has truly benefited from HCP’s accomplishments. In the past, it has been difficult to compare MRI images collected from different scanners or research sites because of the use of incompatible hardware and software technology. The HCP is a move toward hardware and software standardization that allows greater sharing of data between sites and assembly of large clinical and non-clinical data sets. Specifically, a technique called multiband functional MRI (fMRI) used by HCP provides a very high-quality picture of brain activity in a behaving individual. One key to the success of HCP has been the powerful database tool, called XNAT, that is used to organize the MRI data collected. The HCP guidelines and resources should allow us to study whether brain circuitry is altered in persons with psychiatric disorders.
In other settings, HCP is starting to yield evidence of its clinical research utility. For example, one recent study used HCP data to identify potential structural brain differences linked to anxiety and depression. This field is gaining momentum, and the type of research we propose is an example of the promise it holds.
We have much to learn in the emerging field of mind-brain research from combining new technologies with the rich clinical history that can be gathered by experienced and skilled clinicians meeting face-to-face with their patients. This pairing has enormous potential to contribute to our understanding of mental illness. Through the Neural Mediators of Psychotherapeutic Change Strategic Initiative, Riggs is poised to be at the forefront of this work.
 De Witte, N.A.J. & Mueller, S.C. 2016. “White matter integrity in brain networks relevant to anxiety and depression: evidence from the human connectome project dataset.” Brain Imaging and Behavior. 10 (4): 1096-1107. doi:10.1007/s11682-016-9642-2.