All fired up: brain training for anxiety and depression
Australia’s statistics on mental health tell a sobering story about the nation’s collective headspace, with anxiety and depression among the most prevalent conditions. One in four people will experience anxiety in their life, and two million Australians will experience anxiety over a 12-month period. Approximately one million Australians currently suffer from depression and, within twenty years, depression will be second only to heart disease as the leading medical cause of death and disability.
Historically, mental health conditions such as anxiety and depression have been managed with a combination of therapeutic interventions and/or medications, however Curtin academic, Dr Patrick Clarke, School of Psychology and Speech Pathology, is taking a new and innovative approach to understanding the causes and treatment of these debilitating illnesses. Dr Clarke is the first person in Australia to investigate how a combination of neurostimulation and computer-based cognitive training exercises, which target and change the neural activity of the brain, may be applied to the treatment of anxiety and depression.
Feeling blue versus anxiety and depression
Everyone experiences worry, or feeling down from time to time, however this is different to the chronic anxiety and/or depression that affects a significant proportion of the Australian population. According to Dr Clarke, clinical levels of anxiety and depression are characterised by their intensity and their disabling effect.
“An important consideration when distinguishing everyday experiences of emotion from clinical levels of anxiety and depression is its level of interference with someone’s life. Clinical anxiety and depression can be distinguished from day-to-day experiences of these emotions by their level of severity, that is, how intense they tend to be, how frequently people tend to experience these emotions, and how long someone has been experiencing them for,” Dr Clarke said.
“It is difficult to over-emphasise how much of an impact mental health problems can have on a person’s life. It can include everything from limiting the educational and employment choices an individual pursues due to fears over public speaking and social evaluation, right through to the most debilitating levels where people can feel unable to leave their homes for extended periods.”
Training the brain away from anxiety and depression
Dr Clarke believes the anxious or depressed brain can be trained to be more resilient. He uses computer-based cognitive exercises to retrain an individual’s thought patterns so they process information from their environment differently, and ultimately develop a more positive and resilient perspective. This approach is known as cognitive bias modification.
“Cognitive biases are essentially like unhelpful cognitive ‘reflexes’ that skew the information we take in toward more negative and dangerous aspects of the world. This can include processes like attending to more negative over positive information, or interpreting ambiguous information in a negative way,” Dr Clarke said.
“The goal of cognitive bias modification is to alter these automatic reflexes to discourage negative information processing through repeatedly completing set tasks. For example, an individual might complete a task that encourages them to repeatedly attend to more positive, over negative, information. By redirecting patterns of cognition away from negative information the aim is to reduce emotional vulnerability, such as reducing stress in social situations, or specific problems that these biases are believed to exacerbate, such as insomnia symptoms.”
Critically, while it’s well established that biochemical imbalances underpin anxiety and depression, evidence shows that cognitive bias modification can alter activity in the brain.
“There is now clear evidence that cognitive bias modification influences neural activity. Specifically, when people have been (brain) scanned after receiving cognitive bias modification it has shown that there is more activity in areas involved in regulating emotions and directing attention, that is, what we filter in and out,” Dr Clarke said.
While cognitive bias modification has proved helpful for some people suffering from anxiety and depression, it is not an effective treatment for everyone. For those people it helps, the results are longstanding, and it improves resilience rather than mood.
“There is considerable variation in how people respond to cognitive bias modification, some respond very well and others may respond small amount or not at all. What the research suggests however is that when people do respond, the effects tend to be immediate,” Dr Clarke said.
“Interestingly though, this immediate effect is not on mood. Rather it tends to influence response to stress by increasing emotional resilience. Among studies that have delivered multiple cognitive bias modification sessions over a period of four weeks, follow-up has shown enduring benefits at up to eight weeks after the treatment has stopped.”
All fired up: what is neurostimulation and how does it work with brain training?
An increasingly common method of neurostimulation works by using a weak electrical current to stimulate specific areas of the brain. The current is delivered to the brain via electrodes attached to the scalp and, while it may sound confronting, it’s a non-invasive and painless intervention. Dr Clarke is combining neurostimulation with brain training to deliver a supercharged intervention that targets the neural architecture of anxiety and depression.
“As a treatment, non-invasive brain stimulation seeks to target key neural areas of the brain that may be less active in various mental health problems, and so make the brain more receptive to change,” Dr Clarke said.
“The idea behind the combination of these techniques is that the neurostimulation essentially increases the brain’s readiness for change by increasing activity in critical areas, while the cognitive training helps nudge it in the right direction to discourage processing less negative material. While research in this area is at a very early stage, the hope is that these two therapeutic techniques could potentially work ‘hand in glove’ to provide benefits that could be superior to either alone.”
Dr Clarke is hoping to progress this research to larger scale clinical trials in the future.
Where to from here?
Combining neurostimulation with brain training as a treatment for anxiety and depression is still in its infancy, however the results from Dr Clarke’s research date are encouraging. Dr Clarke’s current focus is on building evidence about the efficacy of these treatments for mental health conditions, and their potential for broader application.
“A key goal is to continue to build the evidence about the therapeutic potential of cognitive bias modification and/or neurostimulation, how these techniques can be most effectively used, and who is most likely to benefit from them,” Dr Clarke said.
“Cognitive biases, and biased attention in particular, are known to be present in a range of conditions including addictions, eating disorders and chronic pain, in addition to anxiety and depression. In principle, there could be therapeutic benefits to changing cognitive biases in any of these conditions which may be further enhanced when combined with neuro-stimulation. As yet there has been very little research with such combined approaches.”
Further information about mental health and mental health support can be found at the Beyond Blue website.