Successful mental health treatments can function like a conversation: The brain hears some kind of message — whether it’s from a drug or another approach — and the brain responds in a way that alleviates some symptoms.

Scientists are listening in on those conversations — and trying to “back translate” them to figure out how successful treatments actually work. And that effort is about to get a big boost: The nonprofit Wellcome Trust recently announced a $200 million commitment to support more mental health research, including scientists studying the underpinnings of existing treatments.

“The money is to think about doing things in a different way,” said Andrew Welchman, who oversees neuroscience and mental health work at the Wellcome Trust. The goal isn’t just to understand why treatments work or fail — it’s also to figure out how to tap into those findings to make treatments more effective. Neuroscience experts say that’s direly needed.

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“There’s absolutely no doubt about it. Our treatments don’t reach the number of people they need to,” said Emily Holmes, a clinical neuroscientist at Uppsala University in Sweden.

Many patients don’t respond to treatments. Many cycle through one treatment after another without any relief, hoping to eventually land on one that works. Others find treatments that work for them — but only for awhile. And scientists don’t fully know why that’s the case.

“Some of that is because [the treatments] have quite broad effects, and some it is because the studies haven’t been done,” said Dr. Leanne Williams, a Stanford neuroscientist and the founding director of the school’s Center for Precision Mental Health and Wellness.

The mechanisms that make a treatment work can happen in any number of ways, Holmes said. Back-translating is about figuring out those mechanisms — or the “magic ingredients,” as she calls them.

A drug or treatment might be effective because it produces changes in the brain. But it also might work because it drives other types of changes, like at a cognitive or behavioral level. One example: shifting someone’s cognitive bias. Studies show that when people are shown an ambiguous face, some people are prone to interpret it negatively, and others are inclined to interpret it positively. If a psychological treatment bumps a negative bias toward the center, it could produce downstream effects, like improving a person’s mood.

An example of that idea in action: the work of University of California, Los Angeles, neuroscientist Michelle Craske and her colleagues. They’ve worked to unpackage the mechanisms behind exposure therapy, a common treatment for anxiety disorders that involves repeated exposures to things that a person fears or avoids. It works for some people, but not everyone. Craske and her colleagues are hunting for ways to tweak the treatment’s mechanisms to make exposure therapy more effective.

“If you can back translate the successful treatments we have, it can allow you to ask questions about how to extract the essential ingredients and make them better,” said Holmes.

Williams does her own type of back-translating. Patients who come into Stanford’s precision psychiatry studies go through a battery of tests: They undergo genetic testing and functional MRI scans to capture images of their brain circuitry. They’re evaluated on emotional regulation. They’re quizzed about their symptoms and their quality of life. Then, after weeks of treatment with existing drugs or therapies, they do it all again to see what changed.

Williams and her colleagues use those measures to come up with more precise subtypes of depression and anxiety. They’re also testing whether they can achieve better outcomes when treatment is guided by that testing.

“The best way to reduce the impact of the illness is to get treatment right the first time,” Williams said.

Welchman of Wellcome said he hopes the investment will ultimately produce better treatments for the tens of millions of people across the globe with mental health conditions. The organization is additionally dedicating some of its funding to develop common standards for how anxiety and depression are evaluated, so it’s easier to compare data across different projects. Wellcome is also aiding efforts to create a sweeping database of mental health research that lets researchers mine for patterns.

The investment is still in the early planning stages. But in the meantime, experts are excited that back translation is gaining traction.

“The Wellcome investment comes at a brilliant time,” said Holmes. “The really exciting thing is to have lots of people asking questions in novel ways.”

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  • Spin doctoring has become an artform in academia and research circles. It’s increasingly difficult for the general public to see what’s good science and what’s not as those projects that gain prominence have members that are generally better at networking. One can see immediately, however that this idea is a non starter and it’s mind boggling how 200 million could be thrown at a project with so little likely yield and does more to justify the careers of researchers. Truth be told fMRI is a technological phrenology, a dead end and can’t possibly illuminate our understanding of why or not treatments work. Ironically more funding is creating an imbalance where those adept at getting their hands on it are dictating the direction of science often in non productive areas (none the less affiliated with the prestige of their institutions and easier pathways to high impact journals), but resulting in stifling the diversity in voices. More funding isn’t the answer as this can indeed be wasteful, but a greater randomization of funding and levelling of the importance of work could address the current shortfall in progress.

  • This is really a pernicios form of deceptive marketing. They appeal to the people who wnat to beleive in a quicks fix, or a new magic pill, a fix all. The idea that these biased “researchers’ who are looking for a quick buck, will find anythign worthwhile is rediculous. We see the same kind of manipualtive research, used to justify all kinds of horrers. These researchers either chose to ignore or found facts inconvenient. Study after study shows that exposure to trauma, uncertiantly, deprivations and stress ealry in life, can lead to mental illness. What these clever marketers here want us to beleive is that there are smart people researching it. They are merely seeking attention and funding for their potentially lucrative biased market designed research.
    We saw the same kind of research directed at balming children for not succeeding, justify racism, and even defunding school based lauches for under resourced children to “build character.”

    These clever marketers want us to beleive that looking for certian data points in poorly recorded health billing, which is alrayd subject to bias and non reporting, they can come up with a lucrative treament. It is really no wonder that mentally ill people are still stigmatized, blamed for societies negatives, and left to die of exposure.
    Peopel need to start separating the marketing hype from the facts. These dupes don’t have to find anything beneficial or alleaviate any disease, all they have to do is find something marketable.

  • “Successful mental health treatments can function like a conversation: The brain hears some kind of message — whether it’s from a drug or another approach — and the brain responds in a way that alleviates some symptoms.” — Sorry, but the brain doesn’t “hear” anything. Hearing is something that a person, or a person’s mind, does. This conflation of the brain and the mind is too common today, and stems from lack of understanding as to how the brain and the mind are different yet intimately related.

  • This is more of the same hype and nonsese they have been peddling for years. The most profound fact about all of this is that the resources the individual has accsess to, have a lot do do with outcomes. These clever researchers should be asking, why none of the pharmaceutical data, was collected. They will find that the industry found that inconvenient. They should also ask what happnes when an individual is misdiagnosed, and then Gas Lighted by this industry. No researchers are asking the real questions, instead we get this kind of advertorial form of hype.
    A lot of people have been harmed by the industry over the years, yet none of it was tracked. These researchers are merely looking for a gimmick, by sifting through random data, with gaping holes in it. A lot of peope have died over the years, or have had their lives ruined, due to the current approach. Most of the data collected is limited for a reason, to spur pharma profiteering , and avoid liabality. None of the data they will accsess has the outsomes, deaths or even long term data. In Post Fact America, this kind of cool sounding hype, is really meant to Gas Light the public and give the appearance of a scientifc aproach to a serious topic. What they are really after here is free PR, and some industry funding.

  • If doctors stop giving labels to patients (various names referred to as “mental illnesses”), most people would recover – labeling disempowers patients and lead to nocebo effects (the opposite of placebo effects).

    • “Most people would recover”? Have you ever worked with people with bipolar disorder? Morbid depression? Psychotic disorders? If you had, you’d recognize how silly your claim is.

    • It is not silly. What a person needs for recovery is: hope, support and a psychological atmosphere that can calm the mind. This doesn’t necessarily have to come through professional interventions – it can also happen when circumstances of an individual changes, etc.

      When people are given labels (in the absence of any objective measures, by the way), it gives the impression of a “thing” that exists that is harmful to them) – that itself can have a large negative impact on the person via negative expectations. The following recent randomized study demonstrated how nocebo effects could be quite powerful – it examined how the knowledge of a genetic risk can be physiologically more damaging to an individual than having that risk itself. (A similar situation can happen for psychiatric conditions.)

      Turnwald, B. P., et al. (2019). Learning one’s genetic risk changes physiology independent of actual genetic risk. Nature Human Behaviour, 3(1), 48.

    • You’re talking about people who are relatively healthy. I’m guessing that you’ve never worked as a clinician with very sick patients. Good luck relying on hope and support alone next time you’re managing a bipolar person in the midst of a manic episode. If you should ever actually find yourself in that position . . .

    • They get worse after they are given labels. Are you suggesting that giving people psychiatric drugs is the answer?

    • I’ve personally seen people feel relief after getting a diagnosis because for the first time what they’re experiencing makes sense. And yes, in some situations, psychiatric drugs are the best treatment — maybe not forever, certainly, but for a time. I suspect if you had a family member with a psychotic illness, or with morbid major depresssion, you might end up believing that yourself.

    • Making sense because you want them to believe they have a ‘chemical imbalance’ that somehow needs to be corrected through a pill?
      Anyway, I like the other comment you have posted here regarding the
      the brain and the mind. That IS the correct approach – when the mind is empowered to have more hope and optimism structural changes in the brain happen (through neuroplasticity, etc.).

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