How did cognitive behavioral therapy (CBT) become the one of the most commonly utilized forms of psychotherapy? When did ancient Eastern mindfulness practices become the focus of renowned research labs in the United States? Why are mental health researchers interested in the use of psychedelics for psychiatric treatment? How has the study of adverse childhood events (ACEs) begun to impact the healthcare setting as a whole? It can be easy to forget that mental health research is being conducted all over the world by millions of brilliant minds. Mental health research is constantly evolving with exciting new findings being released each year, and a survey suggests Americans are more prepared than ever before to introduce mental health improvements into their lives. According to a poll conducted by the American Psychiatric Association, 25% of respondents – almost 70 million people – intended to find ways to improve their mental health in 2022. Fortunately, mental health has been at the forefront of the public conversation for several years, and as public interest and acceptance of mental health continues to grow, ongoing mental health research provides fascinating topics for everyone to learn from.
Today’s blog will be something of a smorgasbord of recent findings and avenues being explored in the world of mental health research. From the development of blood tests for depression to the use of virtual reality technology for CBT, there are so many exciting mental health topics to look out for.
What Are Mental Health Researchers Looking Into Recently?
Fast Relief for Agitation in Bipolar Disorder
The FDA recently approved a sublingual – administered beneath the tongue – formulation of dexmedetomidine for agitation in bipolar disorder. Most often, dexmedetomidine is a prescription sedative used to sedate patients undergoing medical procedures, but in a study that prompted the FDA’s approval, rectangular films containing small deposits of dexmedetomidine were used. The study explained, “acute agitation is common in patients with bipolar disorder and requires urgent management to relieve distress and prevent escalation to potentially aggressive behavior.”
The study included 380 participants with bipolar disorder who experienced mild to moderate agitation, and the results were important. At two different doses, sublingual dexmedetomidine treatment resulted in significantly greater reductions in agitation – beginning just 20 minutes after administration and lasting over 2 hours – when compared to the placebo. Further research is needed to understand the spectrum of patients for whom this treatment may be effective, but immediate take-aways suggest sublingual dexmedetomidine could be a useful, fast-acting treatment for agitation in the future, which could prevent situation escalation and potential patient and/or medical personnel injury.
Pharmacogenetic Testing for Choosing Antidepressants
Pharmacogenetic tests look for genes that may affect a body’s response to certain medications. Preliminary evidence suggests pharmacogenetic testing could be useful for selecting antidepressants for individuals suffering from treatment-resistant depression. In a 24-week study with 2000 participants, pharmacogenetic testing examined genes that affect antidepressant metabolism and mechanism of action. The study found that remission at 12 weeks was greater in those being treated with antidepressants guided by pharmacogenetic testing than in those treated with usual care. However, remission rates were nearly identical in the two groups by the 24-week mark. More research surrounding the use of pharmacogenetic testing in antidepressant treatment is needed to establish their clinical utility, but it presents an exciting prospect in the push for more individualized mental health care.
Blood Tests for Mental Illness
Also along the lines of individualized mental health care, researchers from Indiana University School of Medicine (IUSM) are investigating a fascinating possibility – the use of blood tests in identifying psychiatric disorders. Some of the first breakthrough work the IUSM researchers produced involved identifying blood gene expression biomarkers that track suicidality. The blood test they developed was used to assess state (suicidal ideation), predict trait (future hospitalizations for suicidality), and was further validated in suicide completers. The studies showed good reproducibility in subsequent independent genetic studies.
Most recently, the IUSM researchers developed a blood test for the identification and distinguishing of mood disorders – specifically depression and bipolar disorder. Through preliminary investigation, the researchers identified twelve top biomarkers that had the strongest overall evidence for tracking and predicting depression. Of the twelve, six in particular showed strong evidence of tracking and predicting depression and mania, hence bipolar mood disorders. Mood disorders often go misdiagnosed and sub-optimally treated due to a lack of objective tests. Therefore, the clinical use of the IUSM researcher’s blood test for mood disorders could have huge implications for better discernment between mood disorder diagnosis, and subsequently, better treatment for each disorder.
A New Psychotherapy for Psychosis
Despite being treated with antipsychotics and other pharmaceutical agents, several individuals with schizophrenia spectrum disorders continue to experience symptoms. A variant of the widely used cognitive behavioral therapy (CBT), called metacognitive training (MCT), has shown to improve various manifestations of schizophrenia, such as delusional thinking and impaired functioning.
MCT is a psychotherapy that aims to target common cognitive errors and problem-solving biases, which may – on their own or in combination – culminate in the establishment of false beliefs to the point of delusions. The goal of MCT sessions is to raise patients’ awareness of distortions and prompt them to critically reflect on, expand upon, and change their system of problem solving. A meta-analysis of 40 studies that included over 1800 participants found that treatment with MCT led to improvements in delusional thinking, positive symptoms, negative symptoms, and functioning, which were maintained for at least one year. Further research is needed to continue MCT’s integration into the clinical setting, but current data suggests a promising future for MCT as a complementary approach to antipsychotics for the treatment of schizophrenia.
Overarching Areas of Interest in Mental Health Research
In addition to pharmacogenetic testing and blood tests, trauma-informed care is another major avenue the research and medical communities are exploring in hopes of providing more individualized mental health care. Arguably highest on the radar of those exploring trauma-informed care are adverse childhood events (ACEs), which are potentially traumatic events individuals experienced between the ages of 0-17 years old. Examples of ACEs include:
- Experiencing violence, abuse, or neglect
- Witnessing violence in the home or community
- Having a family member attempt or die by suicide
- Growing up in a household with substance use problems, mental health problems, or instability due to parental separation
The data surrounding ACEs is astounding. The CDC explained that about 61% of adults surveyed across 25 states reported experiencing at least one ACE and nearly 1 in 6 reported having experienced four or more ACEs. Even more interesting is the profound impact ACEs seem to have on individuals’ mental and physical health later in life. Having a high ACE score (typically 4 or more) increases individuals’ risks of injury, sexually transmitted infections, maternal and child health problems, involvement in sex trafficking, and a wide range of chronic diseases – including leading causes of death, such as cancer, diabetes, heart diseases, and suicide. Therefore, health care professionals are widely embracing a trauma-informed approach to care in order to provide their patients with the appropriate treatment for their specific needs, and mental health researchers continue to investigate the long-term implications of ACEs to further prompt improvement in clinical settings.
The Use of Technology in Mental Health Care
As telehealth services and crisis lines have shown, technology has introduced a new frontier in mental health support, but that is only the beginning of what kind of role technology may play in mental health care in the future. Advancements in artificial intelligence (AI) technologies could improve the future of therapy sessions and mental illness diagnoses. A study published in late 2021 explored the use of AI motion sensors in the detection of anxiety symptoms, such as nail biting, knuckle cracking, and hand tapping, and developed a deep learning-based model that could recognize anxiety-related behaviors with over 92% accuracy. With more clinical testing, such AI technology could have a permanent place as an objective measure of anxiety presentation, which could complement and improve the current method of diagnosing anxiety disorders.
Another exciting prospect regarding the use of technology in mental health care is virtual reality. In November 2021, the FDA authorized marketing of a prescription-use immersive virtual reality (VR) system that uses cognitive behavioral therapy (CBT) and other behavioral methods to help with pain reduction in patients 18 years of age and older with diagnosed chronic lower back pain. According to the FDA’s notice of authorization, the VR device employs the principles of CBT and other behavioral therapy techniques to “reduce the burden of chronic pain and increase function through an emotional, cognitive, and behavioral approach to shift negative beliefs held by patients about the relationship between their pain and movement.” The VR device is intended for at-home use and also comes with an attachment called a “Breathing Amplifier,” which is used to direct users through deep breathing exercises during their session. Though the VR device is primarily being used to treat chronic pain, immersive CBT using VR technology presents treatment options for ailments that extend far past physical pain. Such technology could provide at-home treatment options for several psychiatric disorders.
As demonstrated by the variety of topics discussed in today’s blog, there is no shortage of innovation when it comes to mental health research, and it’s important to note that the topics discussed today only represent a small fraction of the exciting avenues researchers are exploring. Other important areas of interest include the use of psychedelics and brain stimulation in the treatment of various psychiatric disorders, which you can read more about in our previous blogs.