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"Javanbakht, Arash"
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Afraid : understanding the purpose of fear and harnessing the power of anxiety
About a third of the world population suffers from an anxiety disorder, and half of Americans have had at least one traumatic experience like rape, assault, shooting, or natural disasters. 'Afraid' provides a broad and entertaining overview of fear from evolution, to modern day challenges, and how clinicians treat trauma, anxiety and PTSD today.
Book
Addressing war trauma in Ukrainian refugees before it is too late
Russian invasion of Ukraine has led to one of the largest refugee crises in recent history. Many internally displaced Ukrainians and refugees will need care for PTSD, anxiety, and depression. Here I will suggest practical steps to reduce long-term impact of trauma and stress on refugees' mental and physical health, and functioning. These include mental health first aid in acute phase of arrival, education of mental health and navigating healthcare system in the host countries. As well, training of manualized trauma-focused therapy and intervention methods in the host countries, focused education for physicians on psychopharmacological interventions for common mental health issues among refugees (PTSD, depression, anxiety), and utilization of videoconferencing for treatment, and consultation and supervision for providers.
Many internally displaced Ukrainians and refugees will need care for PTSD, anxiety, and depression to prevent long-term disability and health consequences.
There are challenges in receiving the needed care including stigma, lack of awareness by patients and providers, lack of resources, and lack of skills in trauma-focused treatments.
In this article, suggestions are made on how to overcome these obstacles, that include mental health first aid upon arrival, education for refugees and those serving them, training providers at different layers, and remote treatment and counselling/supervision services.
Journal Article
Gaza’s hidden crisis: adults, children, and generations of psychological torment to come
For more than a year, the world has been exposed to the ongoing conflict in Gaza, and the destruction, medical devastation, and the death toll of this crisis. What has been largely missing from the picture, has been an attention to the long-term mental health impact of the ongoing trauma among the Palestinian civilians and the Israeli hostages in Gaza. This article anticipates the enduring generational impact of war trauma on mental health of the civilians in Gaza, drawing from the author's clinical and research experiences of Iraqi, Syrian, Afghan, African, and Ukrainian war-exposed civilians, refugees, and survivors of torture. Across most different studies, war exposure leads to PTSD in nearly 30-50% of adult civilians, and similar rates of depression and anxiety. Civilians in Gaza, facing daily horrors and a profound sense of helplessness, are likely experiencing even greater psychological distress. Children, significantly affected during critical developmental stages, are at risk of long-term mental and physical health issues. The psychological, cultural, and epigenetic aspects of the intergenerational transmission of trauma can lead to psychological torment across generations. Addressing the mental health needs of these populations is crucial to mitigating the profound and lasting impact of war.
Journal Article
A Theory of Everything: Overlapping Neurobiological Mechanisms of Psychotherapies of Fear and Anxiety Related Disorders
Similarities within the phenomenology, neurobiology, psychotherapeutic, and pharmacological treatments of distinctly categorized anxiety and fear related disorders suggest the involvement of common neurobiological mechanisms in their formation. This theory of integration is the focus of the Research Domain Criteria (RDoC) approach initiated by the NIH. The current article explores potential facets of overlap among mainstream methods of psychotherapy for anxiety, fear, and trauma related disorders. These overlaps include associative learning of safety, cognitive reappraisal and emotion regulation, therapist as a social safety cue, and contextualization. Temporal contextualization and placing memories in their time and place will be suggested as a potentially important, and less explored aspect of psychotherapy.
Journal Article
Neural circuits in anxiety and stress disorders: a focused review
Anxiety and stress disorders are among the most prevalent neuropsychiatric disorders. In recent years, multiple studies have examined brain regions and networks involved in anxiety symptomatology in an effort to better understand the mechanisms involved and to develop more effective treatments. However, much remains unknown regarding the specific abnormalities and interactions between networks of regions underlying anxiety disorder presentations. We examined recent neuroimaging literature that aims to identify neural mechanisms underlying anxiety, searching for patterns of neural dysfunction that might be specific to different anxiety disorder categories. Across different anxiety and stress disorders, patterns of hyperactivation in emotion-generating regions and hypoactivation in prefrontal/regulatory regions are common in the literature. Interestingly, evidence of differential patterns is also emerging, such that within a spectrum of disorders ranging from more fear-based to more anxiety-based, greater involvement of emotion-generating regions is reported in panic disorder and specific phobia, and greater involvement of prefrontal regions is reported in generalized anxiety disorder and posttraumatic stress disorder. We summarize the pertinent literature and suggest areas for continued investigation.
Journal Article
Pathways from parental trauma exposure to Syrian and Iraqi refugee youth mental health symptoms: a multi-level mediation analysis
Background
Trauma experienced by one generation has potential to impact those that follow. Refugee youth in particular are vulnerable to trauma and its intergenerational effects. By examining trauma subtypes, the impact of parental trauma, and post-/pre-migration stressors, this study investigated pathways linking parental trauma to psychological symptoms in Syrian and Iraqi refugee youth.
Methods
Participants included 165 minors from Syria and Iraq, and their 107 parents (56 mothers, 51 fathers), all of whom experienced forced migration due to war and resettled as refugees in southeast Michigan. Linear mixed-effects modeling and multi-level mediation analyses were employed to investigate pathways from parental trauma exposure to child symptoms (anxiety, depressive, and somatic), as well as possible explanatory mediators.
Results
Maternal cumulative trauma and death threat trauma were associated with child depressive symptoms (cumulative: b = 1.64,
p
=.007; death threat: b = 2.70,
p
=.020) and somatic burden (cumulative: b = 0.56,
p
=.032; death threat: b = 1.04,
p
=.041). Anxiety models also revealed an association between maternal cumulative trauma and child anxiety (b = 1.79,
p
=.034). Maternal post-migration living difficulties fully mediated the observed association between maternal cumulative trauma and child depression, though this effect was trending in sensitivity analyses. No paternal trauma variables were associated with child symptoms.
Conclusion
Findings indicate that maternal trauma exposure in particular—as well as elevated post-migration stressors for mothers—may contribute to mental health risk in refugee youth. These insights may be leveraged towards early identification of youth at high risk, and to direct focused intervention towards modifiable targets—including living difficulties (e.g., financial difficulties, access to health care and transportation) experienced by parents post-migration.
Clinical trial number
Not applicable.
Journal Article
Treatments of Posttraumatic Stress Disorder in Civilian Populations
Purpose of Review
Posttraumatic stress disorder is a chronic, heterogeneous disorder for which a multitude of psychotherapies, pharmaceuticals, and immerging treatment programs are available. Majority of efficacy studies focus on Caucasian male military populations, which may be a reason why not all patients respond to treatment with long-term positive outcomes. Additionally, effects of treatment on symptom clusters have been neglected. This work reviews treatment of PTSD and its symptom clusters exclusively in civilian populations, which have been historically under-examined in the literature.
Recent Findings
Exposure therapy stands at the forefront of successful PTSD treatment and offers a more cost-effective solution to pharmacotherapy; however, refugees and patients with comorbid depression may not experience such strong benefits. For exposure therapy and other forms of psychotherapy, non-inferiority studies point to promise of internet-delivered and telemedicine-based methods for reaching populations that may not have access to in-person care.
SSRIs are the most widely used pharmaceutical treatment for PTSD; moderate initial benefits are observed yet long-term retention and outcomes may be enhanced by adjunct treatment. Again, refugees are a group that experiences lesser benefit. Research has begun to explore efficacy of treatments for individual symptom clusters, with hyperarousal benefiting most from currently available modalities. Avoidance, intrusion, negative thoughts and beliefs, and dissociation are symptoms requiring more research for focused interventions.
Summary
Treatment of PTSD has evolved to (1) include equivalent proportions of men and women, along with focused female-exclusive cohorts; (2) explore novel methods of treatment online and in various cultural contexts; and (3) less focus on medication as evidenced by current clinical trials. In addition to further efficacy and safety studies in more diverse ethnic populations, work is needed to examine what therapies are best for targeting specific symptom clusters of PTSD. This research will drive precision treatment, and such research is beginning to point towards underlying mechanisms of pathology and change.
Journal Article
Unreal that feels real: artificial intelligence-enhanced augmented reality for treating social and occupational dysfunction in post-traumatic stress disorder and anxiety disorders
Fear- and trauma-related conditions, such as post-traumatic stress disorder (PTSD) and social phobia, often manifest as socially avoidant behaviours, which commonly contribute to social and occupational disability transdiagnostically. While gold-standard treatments (i.e. exposure therapy, psychotropic medications) are effective, they are hindered by high dropout rates and limited impact on real-world functioning. Furthermore, most existing interventions only target symptom reduction, with few addressing avoidance-related deficits in social and occupational functioning.
This methods paper introduces an innovative augmented reality exposure therapy (ARET) technology designed to address the limitations of traditional interventions for anxiety disorders and PTSD, by directly targeting social and occupational dysfunction through exposure to real-life social contexts.
We introduce an ARET system, using artificial intelligence (AI)-driven, augmented reality (AR) technology, that enables exposure to realistic scenarios within the patient's real-world environment, fostering contextual generalization and functional improvement. Featuring holographic three-dimensional humans, precise surface mapping, wireless mobility, and telemedicine capabilities, the software provides customizable exposure scenarios to transform an environment into various spaces (e.g. grocery store, house party) with diverse human characters, as well as flexible AI-driven human interactions tailored to individual needs.
We share observations and feedback from the treatment of first responders with PTSD. Patients found the technology easy to use, with immersive realism, active engagement, and strong emotional responses needed for effective exposure therapy. Advances in AI-driven character development and AR hardware accessibility support the wider adoption of ARET by clinicians.
By bridging the gap between clinical interventions and real-world functioning, ARET offers a transformative approach to addressing the pervasive impact of psychiatric disorders on social and occupational outcomes.
Journal Article
Pro-inflammatory cytokines level in depressed patients with suicidal behaviour: a systematic review and meta-analysis
Introduction
The study assesses proinflammatory factors in major depressive disorder (MDD) patients with and without suicidal behaviors, and healthy controls, to identify potential biomarkers for suicidal behaviors and prevention strategies.
Methods
We conducted a systematic review, which we have registered in Prospero (#CRD42024547764), and searched through five databases until March 2024. We included observational studies in English that reported on depressed patients with and without suicidal behaviors, as well as healthy controls, and measured the levels of pro-inflammatory cytokines. The Newcastle- Ottawa Scale was used for quality evaluation of the studies and the main analysis was performed using Stata 17.
Results
One systematic review resulted in 4,369 articles but only 24 were selected for the review. The meta-analysis showed depressed patients with suicidal behaviors had significantly higher interleukin (IL)-6 levels compared to the control group with a standardized mean difference (SMD) of 1.26 [0.07, 2.45]; I² = 98.81%. There was no significant difference noted between the depressed patients suffering from suicidal behaviors and those not suffering (SMD 0.42 [-0.58, 1.42]; I² = 98.50%). There is no significant difference between the groups in the levels of tumor necrosis factor-alpha (TNF-α) and IL-10. Further analysis of IL-4, IL-2, IL-1β, IF-γ, and TGF-β1 also indicated no significant group differences.
Conclusion
The review found no significant cytokine differences (including IFN-γ, IL-1β, IL-2, IL-4, IL-8, IL-10, TGF-β1, TNF-α) between depressed individuals with or without suicidal ideation and controls. Variations likely reflect methodological differences, highlighting the need for standardized, longitudinal research.
Journal Article