Eric Garland, PhD, LCSW Associate Professor, College of Social Work Associate Director of Integrative Medicine Supportive Oncology & Survivorship

Transcription

1 Eric Garland, PhD, LCSW Associate Professor, College of Social Work Associate Director of Integrative Medicine Supportive Oncology & Survivorship Program Huntsman Cancer Institute University of Utah

2 I am a LCSW with over 10 yrs. of clinical experience practicing in health, mental health, and addiction treatment settings I completed NIH funded pre and post doctoral fellowships in integrative medicine at UNC My work focuses on transdiagnostic mechanisms: Core cognitive, affective, behavioral, and physiological processes underlying stress related conditions (e.g., ADDICTION, CHRONIC PAIN, CANCER) I use psychophysiological and cognitive neuroscience methods I am the developer of a novel, multi modal intervention based on findings from cognitive, affective, and neurobiological science: Mindfulness Oriented Recovery Enhancement (MORE)

3 I. What Are Biomarkers? II. Why Use Biomarkers? III. A Primer on the Mind Body Interface IV. Specific Types of Biomarkers I. Autonomic Responses II. Neuroendocrine Responses III. Neuroimaging IV. Behavioral Genetics/Epigenetics V. Biomarker Implementation Issues VI. A Demonstration? VII. Additional Examples of Biomarker Research

4 WHAT ARE BIOMARKERS?

5 A characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention (National Institutes of Health Biomarkers Definitions Working Group, 1998) Biomarkers may also indicate psychosocial processes and psychosocial responses to a therapeutic intervention

6 Psych to Phys Parameter Psych to Phys Pattern American Psychologist, 1990, 45(1), Psych to Phys Changes ONE TO ONE e.g., ANGER ONE TO MANY e.g., Slowing of heart rate MANY TO MANY MANY TO ONE

7 Is observed physiological activity a substrate of observed behavior? BEWARE Helpful criteria: Is the phys response necessary for behavior? If the phys response is removed, would behavior be altered? Ultimately, this question is not easily resolved Nonetheless, biomarkers and physiological measures are instruments through which theories may be tested

8 Basal (resting state) psychobiologic function Psychobiologic reactivity to certain types of events/stimuli Psychobiologic recovery from certain events/stimuli Psychobiologic concomitants of cognitive, emotional, and behavioral states Psychobiologic effects of interventions

9 Kosslyn et al. (2002), American Psychologist Within versus between subjects designs change over time versus group comparisons Individual differences versus group effects Should variation be treated as noise or as the focus of research? Blocked versus event related designs

10 A BLOCK: a series of trials is presented during a discrete epoch of time. BLOCKED DESIGN: different conditions are assigned to different blocks. The physiological signal acquired in different blocks is contrasted. Used to identify the physiological response to one type of stimulus (e.g., positive vs. negative) or psychological state (e.g., paying attention versus rest) Assumptions of the Block Design: "Neural structures supporting cognitive and behavioral processes combine in a simple additive manner." Also you may not be able to test certain processes (such as those that habituate rapidly) with such a design

11 Example Blocked Design of Emotion Activation with Pictures Negative Neutral Neutral

12 Used to determine the differential response to a singular presentation of a stimulus or a singular psychological event Types of trials are interleaved and each trial is modelled separately as an event e.g. AABABBAB Analysis of the average response to event type A, B, C, and so on Advantage is you can model individual responses, yet certain processes may take time to develop

13 WHY USE BIOMARKERS?

14 Elucidating mechanism Overcoming social desirability bias Providing objective indices of change Providing treatment targets Strengthening grantsmanship Increasing impact factor Increased numbers of publications/lpus and, most importantly Accords with the biopsychosocial model, biology, physics, and Nature itself!!!

15 ???????????????? Neurobiological Mechanism A* B* Psychosocial Problem Clinical Outcome C C *

16 Neurobiological Mechanism A* B* Intervention Clinical Outcome C*

17 HPA Axis Dysregulation And Hippocampal Cell Death A* B* Physical Abuse PTSD C C *

18 Hypothesis: If dysregulation of the hippocampus and HPA axis is linked with physical abuse and PTSD, treatments that improve hippocampal and HPA function may ameliorate the effects of physical abuse on post traumatic stress symptoms

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20 PTSD Symptoms Mindfulness Training A* Improved HPA Axis Function And Hippocampal Neurogenesis B* C? PTSD

21 Autonomic Dysregulation A* B* Physical Abuse C C * Self Medicating Stress with Alcohol

22 Hypothesis: If autonomic dysregulation is linked with drinking as a means of self medicating stress, treatments that improve autonomic regulation may Heart Rate Variability Recovery From Stress Primed Alcohol Cues (RMSSD, log 10 ) ameliorate self medication with alcohol

23 Improved Autonomic Regulation A* B* Mindfulness Training C? Self Medicating Stress with Alcohol

24 1. Identify pathogenic neurobiological mechanisms of biopsychosocial problem 2. Identify intervention components (e.g., techniques, skills, procedures) that can modulate these neurobiological mechanisms 3. Build these components into existing and new interventions 4. Assess efficacy through RCTs and employ biomarkers of therapeutic mechanism

25 A PRIMER ON THE MIND BODY INTERFACE!