Creative Minds: Helping More Kids Beat Anxiety Disorders
Posted on by Dr. Francis Collins
While earning her Ph.D. in clinical psychology, Dylan Gee often encountered children and adolescents battling phobias, panic attacks, and other anxiety disorders. Most overcame them with the help of psychotherapy. But not all of the kids did, and Gee spent many an hour brainstorming about how to help her tougher cases, often to find that nothing worked.
What Gee noticed was that so many of the interventions she pondered were based on studies in adults. Little was actually known about the dramatic changes that a child’s developing brain undergoes and their implications for coping under stress. Gee, an assistant professor at Yale University, New Haven, CT, decided to dedicate her research career to bridging the gap between basic neuroscience and clinical interventions to treat children and adolescents with persistent anxiety and stress-related disorders.
Gee, a 2015 NIH Director’s Early Independence awardee, is particularly interested in what she calls “safety signals.” Unlike the common approach to fear reduction, in which a child directly confronts a fear to overcome it, safety signals involve linking fears to sensory cues, such as the ringing of a bell, that have been previously presented in a context that provides reassurance. The child is presented with a stressor and a safety signal to condition the mind to activate alternative neurocircuits and relieve fear or anxiety.
Safety signals have been studied primarily in animals, showing, for example, that a stressed mouse can be taught to identify a safety cue to reduce fear. While some safety signal research has been performed in human adults, it has gone largely unexplored in children. Gee will be one of the first to take a detailed look at what happens in children’s developing brains.
To begin, she will determine how a developing brain, which undergoes myriad rearrangements of neural connections through adolescence, inhibits fear. Gee and her colleagues have begun recruiting a mix of anxious and non-anxious kids, aged 6 to 17 years old. They will invite each participant to spend a brief time in an MRI machine while having their brain activity imaged in real-time. Each will hear an aversive sound, white noise akin to fingernails scraping down a chalkboard, and see various geometric shapes. Each shape, serves as a conditioned stimulus, corresponding to the absence or presence of the threat.
Using these stimuli, Gee and her colleagues want to monitor the brain’s ability to differentiate between threat and safety. They will compare responses between children and adolescents as well as among anxious and non-anxious kids. Gee’s hope is to discover where the deficits in fear discrimination take place in the brain and see whether it’s possible to buffer the fear and enhance resilience.
Much of her attention will focus on the brain’s prefrontal cortex, the center of human cognition. Studies indicate it exercises top-down control over another region of the brain called the amygdala, which responds to stress and fear. She suspects in well-adjusted kids, the prefrontal cortex might somehow reduce fear in the amygdala.
Gee is also curious about the hippocampus, which is involved in memory formation and contextual processing. It may form connections with the amygdala before the prefrontal cortex. Gee wonders whether input from the hippocampus enhances the processing of safety signals and help to reduce anxiety in children and adolescents.
Gee doesn’t anticipate any direct clinical interventions to emerge directly from these initial studies. But she hopes that a firmer foundation for understanding the brain during childhood and adolescence will yield new insights about treatment strategies that stand the best chance of helping kids overcome anxiety.
Child and Adolescent Mental Health (National Institute of Mental Health/NIH)
Dylan Gee (Yale University, New Haven, CT)
Gee NIH Project Information (NIH RePORTER)
NIH Director’s Early Independence Award Program (Common Fund)
NIH Support: Common Fund