How can personalized medicine for psychological trauma help reconnect the mind and body?
Ruth Lanius, MD, PhD, is a Professor of Psychiatry and the endowed Harris-Woodman Chair in Mind-Body Medicine. Her research focuses on defining the diverse neurobiology of post-traumatic stress disorder and examining various pharmacological and psychotherapeutic treatment methods. Dr. Lanius dares to ask: How can personalized medicine for psychological trauma help reconnect the mind and body?
By Alexandra Burza, MMJC'19
Every human emotion is manifested in a symphony of corresponding mental and physical symptoms. Our body’s cues urge us to take action, to resolve or express the feelings within.
For people who suffer from post-traumatic stress disorder, these important relationships between the brain, mind and body become out of sync in many different ways. A person’s memory, ability to regulate emotion, sense of self, and even their balance and gait are then affected.
Dr. Ruth Lanius works with military personnel, first responders and civilians who have suffered from psychological trauma, to study the relationship between the brain, mind and body.
In an interview for Western News in July 2019, Canadian Armed Forces Maj. Ronald Miller reflected on his PTSD diagnosis, and his experiences working with Dr. Lanius.
“Over the years, I was exposed to the kind of death and destruction that can be rather difficult from a psychological standpoint,” he said. “I just wasn’t myself. I could see a significant change in my personality that just wasn’t me. I knew I needed to seek help.”
Dr. Lanius explains that in traumatized individuals, the emotions they experienced at the time of the trauma are very painful, yet futile in the moment.
“They can’t act on their body’s emotional cues, and so emotions become useless and people sometimes disconnect from them,” Dr. Lanius said.
Her research has been foundational in defining the diversity of responses to trauma people experience. She has helped characterize a sub-type of post-traumatic stress disorder (PTSD): the disassociative subtype, associated with individuals who experience emotional detachment.
For those with who are diagnosed with the disassociative sub-type, the emotional experience of their trauma has proved too overwhelming, causing the detachment. With these patients, Dr. Lanius says the path to healing is finding a way to reconcile that connection to their emotions and their self-identity. In patients whose post-traumatic stress disorder manifests as a hyper arousal of emotion, the neurobiological changes are different; it’s about restoring the brain-to-body connection responsible for emotional regulation.
Dr. Lanius is focused on understanding these differences in the neurobiology of PTSD patients, and examining treatment methods which can target their specific difficulties. Using functional magnetic resonance imaging (fMRI), Dr. Lanius identifies individuals’ brain activation patterns in response to recalling a traumatic memory, or engaging in a memory task.
What she discovered is that traumatized individuals’ brain networks are organized very differently than those of someone who has not experienced significant trauma, even when then brain is at rest. For example, activity in the central autonomic network, which is responsible for regulating heart rate, is disconnected from actual heart rate variability measures. In individuals without psychological trauma, these systems work in unison, allowing the brain to send signals to the heart to influence heart rate variability.
“Heart rate variability is really a marker of emotion regulation capacity, of how quickly you can adapt to different situations,” Dr. Lanius said. “But the affected networks are also critical to cognitive functions such as focusing, memory and planning, as well as a person’s sense of self.”
For 60 per cent of patients, current treatment options for PTSD, are not effective in completely restoring the mind-body-brain relationship. Dr. Lanius’ research recognizes that the diversity of trauma experiences and brain network dysfunction in patients with PTSD necessitates personalized, targeted medicine.
“People often have complex problems in multiple domains, and we really need to asses all of these domains and tailor the treatment to the individual,” she said, “I think the critical future direction is to develop novel treatments that are based on the brain network dysfunction that we are seeing.”
Recently, Dr. Lanius conducted a randomized control trial of neurofeedback treatment, which aims to teach participants self-regulation of brain function through interaction with a computer game; effectively, re-training their brains. The trial tested neurofeedback with a group of participants who were diagnosed with PTSD, as well as a control group of healthy individuals.
The trial has offered evidence that this treatment can significantly decrease PTSD symptoms, and even restore some of the major brain networks affected by trauma. After treatment, 61.1 per cent of participants no longer met the definition for PTSD, promising results which show how neurofeedback can be an effective part of a personalized treatment plan.
Dr. Lanius believes one of the brain networks impacted by this type of treatment, known as the default mode network, may be responsible for an individual’s sense of self. A loss of self-identity is often at the core of trauma, and many individuals see themselves very differently post-trauma, which can prove difficult to overcome. By addressing the brain network dysfunction, neurofeedback could prove successful in helping re-establish a sense of self.
“Often, people who have experienced trauma feel that they will never be the same again, they feel the world will never be the same again and they see themselves very differently, which can be disturbing to them,” she explained.
The resources and opportunities provided by the endowed Harris-Woodman Chair has allowed Dr. Lanius to dedicate herself to research while still continuing her clinical practice, keeping a foot in both worlds.
“In order to be a clinician-scientist, I need to have a first-person perspective of patients to inform my research,” she said.
Post-traumatic stress disorder affects approximately eight per cent of the population and can carry many impacts on the lives of those affected, including subsequent mental illnesses such as depression, alcohol and drug dependency, and an inability to thrive in interpersonal relationships. Research into this area is crucial to not only helping those with a PTSD diagnosis, but contributes to understanding trauma as a whole.
“Trauma is something that we all experience at some point in our lives, it’s a part of the human condition, Dr. Lanius said.
In her work as a clinician, Dr. Lanius says she is often inspired by the resilience of PTSD patients, and how, despite often long and difficult courses of treatment, many are able to adapt and heal. She hopes to continue to innovate within the sphere of targeted treatments for the condition and improve outcomes for her patients.
Daring to Ask is a series that profiles Canada Research Chairs and Endowed Research Chairs at Schulich Medicine & Dentistry. These researchers are advancing knowledge in their respective fields, asking and answering questions that challenge that status quo and seeking to improve patient care. It is essential research made possible by generous donors and the investment of funding agencies.