This story, written by Elaine Vitone, is adapted from the fall 2017 issue of Pitt Med magazine.
If doctors ask people with depression to reflect on their experiences, they tend to gloss over the good stuff. “It’s: Yeah, I went and had a great dinner with my kid ... but then we went home and got in a fight the next week. Positive memories are ignored or discounted,” says Kymberly Young, assistant professor of psychiatry at Pitt.
As a postdoc at the Laureate Institute for Brain Research in Tulsa, Oklahoma, Young uncovered a surprising new insight into depression. At the time, Young was conducting imaging studies of the amygdala, a brain region that has historically been seen as a seat of fear and other negative emotions — but as it turns out, it’s more than that. The amygdala responds to anything that’s important to you, either in your environment or in your thoughts, Young explains. “It’s actually a salience detector.”
Young observed the brain activity of patients with depression as they reflected on their memories, and she saw a pattern: The amygdala’s activity was unusually high as patients thought about negative memories, and unusually low through the good stuff. And interestingly, as these volunteers emerged from the scanner, many reported the same curious phenomenon: When they were instructed to focus on their memories, both good and bad, they got a little rush from it. Which gave Young an idea.
Young teamed up with Jerzy Bodurka, a physicist and chief technology officer at Laureate Institute who was developing a new application for brain imaging technologies, called neurofeedback. Like biofeedback, it uses real-time physiological activity data to enable conscious control over unconscious processes. The pair wondered if, just like a person can learn to control her heart rate by focusing on her own EKG strip in real time, someone with depression could use functional magnetic resonance imaging to control his amygdala activity at will.
Heartened by the results of a small pilot study, the team then validated their findings in a follow-up study, the results of which came out in the American Journal of Psychiatry earlier this year. The study showed that after just two sessions, participants’ depression scores dropped by half. And one week out, one-third of the patients no longer met the criteria for depression at all.
Here’s how neurofeedback works: The volunteer climbs into the scanner and is asked to think about three positive memories. Meanwhile, the patient looks at a thermometer on a screen — the “temperature” represents the amygdala’s level of activity. The patient aims to raise the temperature to a given target. The researchers then raise the target incrementally, as amygdala activity increases.
For people often caught in a negative-feedback loop, this experimental treatment creates a positive one. They go into the scanner with three positive memories — they come out with somewhere between seven and 12. “It leads to a cascading effect,” Young says.
When Young first started this work, she got some snide comments. “The most common was, Well, Peter Pan says, ‘Think happy thoughts, and then you’ll fly,’” she says. But Young has learned to embrace the metaphor. If the Darling children of Sir James Matthew Barrie’s novel were to heed that advice and step out of a window, they couldn’t fly — unless they had pixie dust onboard.
“I’m considering amygdala activity the pixie dust,” Young says. “It allows you to use the positive memories in a way that is helpful and useful,” rather than continuing to discount them. Because it’s not as simple as thinking happy thoughts, she says. Unfortunately, the more people tell depressed patients simply to “think positive,” the worse it makes them feel. “The research has shown that,” Young notes. Amygdala activity may be the magic ingredient that’s missing.
In the future, Young, who is funded by the National Institute of Mental Health and the Brain and Behavior Research Foundation, hopes to help make neurofeedback more widely available. She also plans to work with therapists to share what she’s learned. Cognitive behavioral therapy could be enhanced by these insights, she believes.
Her study volunteers immediately warm to the idea, she says. “They’re not taking a drug, they’re not talking to a stranger about their mother. [The technique] is informed by neuroscience; it’s a train-your-brain intervention — and they enjoy it.”