MICA: The Translational, Computational and Neurocognitive Basis of Anxiety

One in four of us will suffer from some form of mental health problem in a given year. For the majority of us, this will be some form of anxiety or stress related problem. Some people's anxiety is so crippling that they end up housebound. Anxiety costs the UK economy over £14 billion a year. We currently have effective clinical treatments, both psychological (i.e. therapy) and pharmacological (i.e. medication), that can treat anxiety. However, we are not currently able to effectively target these treatments to people who will respond. In fact, for most people, the first treatment that they try will not work. Even more worrying is that for up to 25% of sufferers; none of our current treatments will work. There are at least two reasons that we have these problems targeting treatments: I) We do not know how our current treatments work at a biological level II) We do not know how debilitating feelings of anxiety emerge from the underlying biology. Without a better understanding of both of these issues we will not improve our ability to target treatments. This fellowship therefore seeks to improve our understanding of the biological basis of anxiety symptoms and treatments. It focuses on psychological treatments and aims to better understand 1) the neural circuitry by which psychological treatment works; 2) develop new psychological treatments; and 3) better refine our understanding of the biological bases of anxiety diagnosis. Specifically: 1) Neural Circuitry: Over the last decade, I have identified a brain circuit which drives feelings of anxiety but we do not know if it changes following treatment. In this project I will scan the brains of anxious people undergoing psychological treatment for anxiety and compare them to anxious people who are not. If we show that this same circuit is important for treatment response, it will enable us to better target treatments to individuals, and reduce the number of people who try treatments that do not work for them. 2) Treatments: In parallel with this I will attempt to develop a new computerised treatment for anxiety. This is possible because my advances in a new field known as computational psychiatry have given us tools that provide better insight into the computational process of the brain, and how they change in anxiety disorders. I will therefore develop a computerised training procedure that targets these computational processes and test it in a treatment study. If this works, it will provide a quick and cost effective treatment that could be delivered by smartphones and ultimately reduce the number of individuals suffering from anxiety. 3) Diagnosis: Finally, I will try to improve our understanding of how debilitating feelings of anxiety emerge in the first place. It is increasingly clear that our current diagnoses, which are based on symptom checklists, do not reflect truly separate biological categories. I will therefore search for 'trans-diagnostic' dimensions that drive anxiety but which cut across our current categories. I shall do this by getting thousands of people to complete a simple psychological task online that I have previously linked to debilitating anxiety. In addition, we will collect a wide range of other psychological tasks and questionnaires from these people. Applying state-of-the-art statistical methods to this 'big data' will enable us to identify trans-diagnostic dimensions that drive anxiety symptoms. In the long term these new trans-diagnostic dimensions will improve our ability to determine the biological factors driving symptoms and hence help us predict treatment response and develop new treatments. In sum, I will combine my unique inter-disciplinary skill-set, with my breakthroughs in delineating the neural and computational basis of anxiety, to develop new and more effective clinical tools for anxiety diagnosis and treatment, with the ultimate goal of improving the quality of life for millions of sufferers.