Researchers track how behavioral therapies change brain function

The University of Illinois at Chicago has received a three-year, $2.5 million grant from the National Institutes of Health to study brain function to see how behavioral therapies affect patients’ ability to follow prescribed drug regimens and lifestyle recommendations.

Dr. Jun Ma, professor of health policy and administration in the UIC School of Public Health and co-director, Center for Research on Health and Aging in the UIC Institute for Health Research and Policy.

Using brain scans, mobile technology, and virtual-reality experiments, the researchers will investigate how the brain responds to two integrated behavioral therapies to help patients with co-existing obesity and depression to manage both conditions. The researchers will then try to optimize the therapy and follow the further changes in the brain and improvements in mood and weight loss.

“Being able to adopt and stick to lifestyle changes is a reflection of a patient’s ability to self-regulate, or manage their health issues on their own, by making healthy choices and adhering to the advice of their care team,” says Dr. Jun Ma, professor of health policy and administration in the UIC School of Public Health and principal investigator on the grant. “If we know more about how the brain changes or adapts in response to behavioral therapy, especially areas involved in self-regulation, then we can begin to tailor therapy to individual patients.”

Leanne Williams, research professor of psychiatry and behavioral sciences at the Stanford University School of Medicine is co-principal investigator on the grant.

Before a drug is approved and marketed, much is already known about the way it works, said Ma, who co-directs the Center for Research on Health and Aging in UIC’s Institute for Health Research and Policy. In contrast, the mechanisms of prescribed behavioral therapies are not well understood. Proven behavioral interventions exist for treating depression and obesity that help patients change their thinking to make better choices and improve their health, but little is known about how they work at a neurobiological level — or why they work for some people and not others.

“This study will help us find answers to these fundamental questions so that therapies can be optimized and tailored,” Ma said.

The three-year study is first phase of a two-phase, five-year project funded through the NIH Common Fund’s Science of Behavior Change roadmap initiative.

Ma and her co-investigators at Stanford University School of Medicine, Palo Alto Medical Foundation Research Institute, and the University of Washington, Seattle, will enroll 100 adults with co-occurring obesity and depression who are currently part of RAINBOW, a five-year randomized controlled trial led by Ma and Lisa Goldman Rosas, assistant scientist at the Palo Alto institute and an instructor of medicine at Stanford’s Prevention Research Center.

RAINBOW, which is also funded by the NIH, seeks to determine the effectiveness of integrated, proven behavioral therapies for obesity and depression provided by a lifestyle coach in a primary-care setting. Intervention consists of psychotherapy focusing on problem-solving skills, with the option to add medication, in addition to counseling on healthy eating and active living to lose weight.

Patients in the new study will continue to receive either standard care or the integrated intervention through the RAINBOW trial, but they will undergo additional tests to reveal how the interventions work at the neurobiological level. Functional magnetic resonance imaging (fMRI) brain scans will be done before the start of behavioral therapy and after four weeks and six, 12 and 24 months of therapy to track changes in brain function. The participants’ brain activity will be compared to control subjects who didn’t receive the intervention.

In collaboration with Stanford’s Virtual Human Interaction Lab, Ma and her colleagues will also assess emotional, cognitive, and self-reflective regulation by exposing participants to simulations of real-world situations in a virtual environment.

The researchers will also collect information on the subjects’ social engagement through an app on their smartphones.

“It doesn’t collect any content, just usage patterns,” Ma said, but tests have shown that certain patterns indicate depression. “If we know how usage looks for someone with depression, we can see how our depressed and obese participants’ usage patterns compare — and if they start to look more like healthy people’s usage as they get treatment.”

The study is a “groundbreaking step in the field of precision lifestyle medicine,” Ma said. “It will let us develop and validate the tools we need to be able to adjust and guide behavioral therapies based on neurobiological mechanisms — so that they are precise and personalized for the individual, and are scalable and sustainable for population health management.”

Dr. Mark Snowden of the University of Washington and Stanford’s Rosas are co-investigators on the grant. Dr. Ma conducts her research through the UIC Institute for Health Research and Policy.