It's summertime in Tulsa, OK and this week our temperatures are projected to hit the triple digits. We asked Dr. Martin Paulus to discuss some of the latest research on the effects of heat on mental health and recommendations for what you can do to stay healthy as temperatures rise.

Dr. Martin Paulus is the Scientific Director and President of Laureate Institute for Brain Research (LIBR) and a Professor at Oxley College of Health Sciences at The University of Tulsa. 
 
Q: Can excessive heat really affect mental health?
A: Evidence does support that theory. Signs that heat is affecting a person can include changes in mood, feeling more irritable, anxious, or depressed than usual. Heat can also make it harder to concentrate or think clearly; it can also disrupt sleep, which can worsen mental health conditions like anxiety and depression.

If someone already has a mental health condition, they might find that their symptoms get worse when it's hot. We recently reviewed three peer-reviewed studies; the studies found that when it gets really hot outside, people tend to have more mental health problems. You can read the full studies here, here and here.

Q: What are the signs of how heat may be affecting your mental health?
A: There are 3 main ways the heat may show effects on your mental health:

Physical symptoms: Heat can also cause physical symptoms that affect your mental health. For example, you might feel more tired than usual, have headaches, or feel dizzy or nauseous. These physical symptoms can make you feel anxious or down.

Changes in behavior: You might find yourself acting differently when it's hot. For example, you might be more impulsive, or you might have a hard time controlling your anger.

Worsening of existing mental health conditions: If you already have a mental health condition like depression, anxiety, bipolar disorder, or schizophrenia, you might notice that your symptoms get worse when it's hot.

Note: Some people take medication to help with their mental health problems. But when it's hot outside, these medications might not work as well, or they might have more side effects. Doctors need to keep this in mind when they're helping patients during hot weather.

Q: How intense can these behaviors become?
A: Unfortunately, thinking about suicide is something to be aware of. We do still need more research, but these studies found that when the temperature goes up, sadly, so do suicide rates. This seems to be especially true for men and older people. This means that when we're trying to prevent suicide, we should think about how hot weather might be making things worse. Additionally, people who already have mental health problems might feel even worse, and they might need to go to the hospital more often. This means that hospitals and clinics need to be ready for more patients when there's a heatwave.
 
Q: Climate change is making hot days and heatwaves more common. Is there a concern that there’s a relationship between climate change and mental health problems?
A: Yes. One of the studies even predicted that if we don't do anything about climate change, there could be thousands more suicides in the US and Mexico by the year 2050.
 
Q: What else do we need to consider?
A: Even though these studies tell us a lot, there's still a lot we don't know. We need more research to understand how hot weather affects different types of mental health problems, what the "danger zone" temperature might be for mental health, and how being inside vs. outside might make a difference.

Overall, these studies show that hot weather and climate change can make mental health problems worse. This is a big deal, and it's something that doctors, hospitals, and people who make health policies need to pay attention to. We also need more research to help us understand and deal with this problem better.
 
Q: What can people do to help manage their symptoms and stay more comfortable in extreme heat situations?
A: Stay hydrated: Dehydration can worsen feelings of anxiety and irritability. Make sure to drink plenty of water throughout the day, especially if you're sweating a lot.

Stay cool: Try to spend time in air-conditioned places if possible. If you don't have air conditioning at home, consider visiting a public place that does, like a library or shopping mall. You can also use fans, take cool showers, or use cold packs to help cool down.

Avoid the hottest part of the day: If possible, try to stay indoors during the hottest part of the day, usually between 10 a.m. and 4 p.m, but often later in the Tulsa area. If you need to be outside, try to stay in the shade. Wear appropriate clothing: Wear lightweight, loose-fitting clothing to help stay cool. Light-colored clothing can also help reflect the sun's rays.

Take care of your physical health: Make sure to eat balanced meals and get plenty of sleep. Both can help manage mental health symptoms.

Practice stress management techniques: Techniques such as deep breathing, meditation, and yoga can help manage feelings of stress and anxiety.

Reach out to others: If you're feeling down or anxious, don't hesitate to reach out to friends, family, or a mental health professional. They can provide support and help you find ways to manage your symptoms.

Follow your treatment plan: If you have a mental health condition and are under the care of a healthcare provider, continue to follow your treatment plan. If your symptoms are getting worse, contact your healthcare provider. They may be able to adjust your treatment plan to help manage your symptoms during periods of extreme heat.

Want to know more? Here's a podcast segment on climate change and mental health with Dr. Nick Obradovich on NPR's 1a podcast and a Mashable article focused on similar research.

Tulsa, Okla. – A pioneering study conducted by researchers at the Laureate Institute for Brain Research (LIBR) in Tulsa, Okla., has made significant strides in understanding the elusive gut-brain connection, a complex relationship that has long puzzled scientists due to the difficulty of accessing the body's interior. The study, “Parieto-occipital ERP indicators of gut mechanosensation in humans,” appears in the peer-reviewed scientific journal Nature Communications.
 
The research team successfully had participants swallow a minimally invasive vibrating capsule to measure neural responses during gastrointestinal stimulation, providing a novel approach to study this intricate connection. The capsule was developed by Vibrant Ltd. Participants in the study included healthy adult male and female volunteers ages 18-40. The researchers found that the volunteers were able to sense the stimulation of the vibrating capsule under two conditions: normal and enhanced. The enhanced stimulation condition led to improved perceptual accuracy, faster detection of the stimulation, and reduced variability in reaction time, indicating potential for studying this method in different clinical populations. This is a significant breakthrough as it demonstrates the feasibility of this novel approach to studying gut feelings.
 
The researchers also discovered the “gastric evoked potential,” a late neural response in certain areas of the brain specifically induced by capsule stimulation. These neural responses increased in amplitude depending on the intensity of the stimulation and were significantly correlated with perceptual accuracy. This discovery provides a new way to measure and understand the neural processes governing the gut-brain connection.
 
“We were able to localize most of the capsule stimulations to the gastroduodenal segments of the digestive tract using abdominal X-ray imaging,” said Dr. Sahib Khalsa, a psychiatrist and neuroscientist at LIBR, and senior author of the study. “This finding is crucial as it provides a more precise understanding of where these gut-brain interactions are originating.”
 
“The potential clinical implications for the results of this study are substantial,” said Dr. Khalsa. “The vibrating capsule method could transform the clinical approach to disorders of gut-brain interaction, including eating disorders and certain gastrointestinal disorders such as irritable bowel syndrome (IBS) or functional dyspepsia.”
 
Dr. Khalsa continued. “This would provide a much-needed tool for assessing gut sensation in these conditions and could lead to more personalized and effective treatment strategies. It also opens up the possibility of identifying perceptual or biological mediators of successful treatment, which could serve as predictive markers for future therapeutic interventions.”
 
The research team was led by senior author Sahib Khalsa, MD, PhD, Director of Clinical Operations at the Laureate Institute for Brain Research and Associate Professor in the Oxley College of Health Sciences at The University of Tulsa. Co-first authors on the study were Ahmad Mayeli, PhD and Obada Al Zoubi, PhD who were a PhD student and postdoctoral scholar, respectively, from LIBR at the start of the project.
 
The research was supported by the National Institute of Mental Health and the Laureate Institute for Brain Research and was conducted at LIBR between September 2019 and February 2022.
 
CONTACT: For more information about the project, contact Sahib Khalsa, MD, PhD, at Laureate Institute for Brain Research at skhalsa@laureateinstitute.org. 

The research of Dr. Martin Paulus, Scientific Director and President of Laureate Institute for Brain Research (LIBR) focuses on three main areas:

• Using neuroimaging to develop predictive biomarkers for anxiety disorders and addictive disorders.
• Using computational psychiatry to better quantify the behavioral dysfunctions in individuals with mood, anxiety, and addictive disorders.
• ​Developing a research pipeline that enable one to translate basic neuroscience discoveries into clinically useful tools.

 
Q: You recently co-authored a review (Screen Media Activity in Youth: A Critical Review of Mental Health and Neuroscience Findings) that looks at the relationship between screen media activity (SMA), mental health, and brain processes. What are researchers finding that will be most useful to parents?

A: As parents, it's crucial to be aware of how Screen Media Activity (SMA) - time spent on screens like TVs, computers, mobile phones, and video games - can affect your child's mental health and overall well-being. One of the most important research findings involves the how SMA affects sleep. Excessive time spent on screens, particularly watching videos and playing video games, can negatively impact your child's sleep. This includes shorter sleep times and more difficulty falling asleep. It's particularly important for young girls who spend a lot of time on their smartphones, as they're more likely to have sleep problems. Consider setting boundaries for screen time, especially before bed, to help ensure a good night's sleep.

Q: Some parents say when their kids spend a lot of time online it affects their mood. Do the research findings support this?

A: Researchers have found that spending too much time on screens can increase the risk of emotional problems like depression and anxiety in children and teenagers. Using social media for extended periods can also lead to increased feelings of family conflict and reduced support from friends and family. Be aware of your child's online habits and ensure they have plenty of opportunities for offline social interactions.

Q: The relationship between screen time and attention or thinking skills isn’t exactly straightforward. Can you share what that means for parents?

A: Some studies suggest that playing video games might improve attention, but more research is needed. Importantly, juggling multiple forms of media at the same time - like texting while watching TV - can be associated with issues like impulsiveness and lower working memory but it is not clear from the research which is cause and which is consequence. Nevertheless, I would suggest to encourage your child to focus on one activity at a time.

Q: What are some other SMA effects researchers are studying?

A: The effects of screen time can vary widely. For instance, more screen time can be linked to unhealthy eating habits and weight gain, lower emotional understanding, and poorer academic performance. But, it doesn't necessarily mean your child will be less physically active. Interestingly, watching TV and playing video games can affect children and teenagers differently. Excessive screen time has also been linked to a range of behavioral and learning issues. It's important to monitor your child's screen time and encourage a range of activities beyond screens.

In summary, while technology is a part of our lives and can have benefits, excessive screen time can have negative impacts on various aspects of your child's life. Balance is key. Encourage a variety of activities - both online and offline - and set healthy boundaries around screen time. Keep an eye on your child's behavior and step in if you notice any issues. As always, if you're worried about your child's mental health or behavior, don't hesitate to seek professional help.

As a principal investigator and Director of Native American Research and the Electroencephalography Core for LIBR, Dr. Evan White, Ph.D. dedicates much of his professional effort to working with American Indian communities to advance mental health. The focus of his work is employing clinical neuroscience to improve mental health outcomes among AI communities—in particular, his research looks at two things: cultural engagement and the role it may play in providing protection against poor mental health outcomes; he also works to identify the signatures of those cultural protective factors that may enhance culturally informed prevention and intervention efforts.
 
How does your work help advance health equity? What are you seeing in the American Indian communities?
In the scope of mental health studies, our work is very much in the early stages. Unfortunately, many mental health disparities among American Indian (AI) populations remain and are potentially even growing.

We have not observed changes in health disparities attributable to the research we’re doing; however, this work is advancing health equity in important ways. Native populations are vastly underrepresented in clinical neuroscience research, particularly as a population of focus. We are working to remedy this by placing AI communities at the center of our clinical-cultural neuroscience research, and by building community partnerships to collaborate in our research process.

The broader goal is to incorporate principles from community-engaged research methods (Community-Based Participatory Research/CBPR in particular) whenever possible. It’s important to note that this endeavor is not unique to our research, and encouragingly, our research is informed by a substantial and growing body of health equity researchers who champion community-grounded health equity research.

What are your research goals, purpose and aim?
My research aims to establish and advance a neuroscientific understanding of cultural factors that are protective against poor mental health among American Indians (AI) utilizing a strength-based framework. My goal is to integrate clinical and cultural neuroscience to identify modifiable factors as candidate treatment targets for mental health intervention and prevention.

We are working to establish a clinical-cultural-neuroscience framework in which mental health intervention and prevention efforts are culturally grounded, community-engaged, and guided by neuroscience.
 
You are an enrolled member of the Absentee Shawnee Tribe of Oklahoma. ​Does your identity as a tribal member inspire you to research minority health, health disparities, and health equity?
Improving the health and wellbeing of the populations we serve is a motivation many researchers share, and my commitment to helping the community I come from is no exception. However, my motivation extends to other communities and populations that also experience disparities and it is my hope that our work can make a meaningful impact at home and more broadly.

In the scientific and medical communities, it is a well-known fact that minority communities are disproportionately impacted by mental health risk factors and, as a result, mental health conditions. Like many native people, I have seen first-hand the impacts of suicide, substance misuse, and addiction. As health disparities researchers we can play an important role in helping to address these conditions.
​
On a positive note, I have also seen the incredible strengths and resilience of Native people and communities rooted in relationships and traditional cultural practices and values. I believe this is a critically important area for mental health disparities research – a community-grounded understanding of treating and preventing disparate mental health conditions which leverages and elevates the strengths that exist within communities.
 
Are there any studies you’re recruiting for right now? What type of volunteers do you need? Are volunteers paid, and what’s involved in being a volunteer?   
We are always interested in people willing to participate in our research studies. Individuals who participate are compensated for their time and can expect to answer questions related to their health and general life experiences. If individuals qualify for one of our studies based on a variety of factors, they may be contacted to complete some additional protocols that include interviews, computer tasks and even brain scanning.

This is a big question: How do we encourage the next generation of scientists?
I know that for me, I received encouragement to pursue my passion from supportive mentors, training programs, colleagues, and family and friends outside of academia. The support I am given helps me find ways to encourage the next generation of scientists.

We need to engage students with hands-on research opportunities early in their training—and not just data collection and curation—but also with idea development, generating research questions, analytic training, and opportunities to share and present findings with a broad audience. Providing training like this in an inclusive and growth-oriented environment allows trainees to explore and develop their own passions for research. We have created these experiences at LIBR in recent years with the LIBR Accelerated Summer Research Internship and Diversity, Research, and Mental Health Neuroscience (DReaM-Neuro) fellowship programs. 

Dr. Steven Cole - May 2, 2023

"Social Regulation of Human Gene Expression"

William K. Warren, Jr.  Frontiers in Neuroscience Lecture 
12:00 pm - 1:00 pm Program in the LPCH auditorium  (No registration needed)

Steven Cole is a Professor of Psychiatry & Biobehavioral Sciences and Medicine in the Division of Hematology-Oncology at the David Geffen School of Medicine at UCLA.  His research utilizes molecular genetics and computational bioinformatics to analyze the pathways by which social and environmental factors influence the activity of the human genome, as well as viral and cancer genomes.  He pioneered the field of human social genomics, and discovered the "Conserved Transcriptional Response to Adversity" that mediates health disparities via neural regulation of inflammatory genes and antiviral genes in monocytes.  He serves as Director of the UCLA Social Genomics Core Laboratory, and is a member of the Jonsson Comprehensive Cancer Center, the Norman Cousins Center, the UCLA AIDS Institute, the UCLA Molecular Biology Institute, and a Fellow of the American Association for the Advancement of Science.

Learning objectives: 

1. Will be able to name two types of genes that are sensitive to social environment regulation in humans.
2. Will be able to describe one neurobiological pathway through which social factors can affect human gene expression.
3. Will be able to describe one type of intervention that can reduce adverse social influences on gene expression.
   
   

For Physicians: Saint Francis Health System is accredited by the Oklahoma State Medical Association to sponsor continuing medical education for physicians.

Saint Francis Health System designates this live activity for a maximum of 1 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
For Psychologists: The Oklahoma State Board of Examiners of Psychologists, the American Psychological Association and the Oklahoma Psychological Association recognize AMA PRA Category 1  credit™. Saint Francis Health System is accredited by the OSMA
 
For Social Workers: Saint Francis Health System is an approved provider of continuing education for social worker through the Oklahoma State Board of Licensed Social Workers for 1 hour Category 1 Clinical. (CEP Number - 20230007)
 
For CADCs and LADCs Saint Francis Health System is accredited as a provider of continuing education programs for CADCs and LADCs through the Oklahoma Board of Licensed Alcohol and Drug Counselors.      (1 hour)

Dr. Salvador Guinjoan is a Principal Investigator at LIBR and Research Associate Professor at The University of Tulsa. He is working on the definition of neurobiological signatures of transdiagnostic clinical manifestations (especially rumination, a well-known adverse prognostic factor in a variety of psychiatric conditions), with the purpose of attaining a better definition of both 1) disease processes which transcend current psychiatric diagnostic categories, and 2) prognosis and prediction of response to treatment, especially in the mood and anxiety disorders. To this end, he is studying a large sample of healthy participants and patients with nonpsychotic disorders (T1000). He is also helping to define experiments that characterize -and modulate- structural and functional brain circuits in such disorders, with the ultimate goal of providing the treating clinician with diagnostic and prognostic tools based upon quantifiable neurobiological variables.

What is your research study about?
 
We are using a new technique called low-intensity focused ultrasound, which allows us to modulate the activity of small and well-defined areas in the brain using a non-invasive brain scan.
 
Our goal is to define brain circuits that sub-serve our behaviors, thoughts, and emotions. In particular, we are interested in modulating brain connections involved in rumination. Rumination is a repetitive pattern of thinking, primarily self-relevant negative thoughts and memories. Rumination is associated with more difficult treatment of depression. If we were able to resolve it, in theory, we could also improve the prognosis of depression in general.
 
What is focused ultrasound?
 
Focused ultrasound is a novel technique to influence the activity (or the structure) of areas anywhere in the brain, in a non-invasive, painless, and safe way. We are only using low-intensity focused ultrasound, which modulates brain activity for a relatively short period of time. Alternatively, when used with high intensity in a neurosurgery setting, focused ultrasound can produce well-defined, circumscribed lesions in circuits that have been demonstrated to improve neurological conditions such as Parkinson’s disease and essential tremor, which might be useful in psychiatric conditions such as obsessive-compulsive disorder and major depression. Low-intensity and high-intensity ranges are well-defined and, in fact, use different devices. Again, we only use low-intensity focused ultrasound.
 
How is the study being conducted?
 
Participants in the study undergo an initial eligibility evaluation. Eligible participants include healthy, unmedicated persons, as well as persons with depression and varying degrees of rumination as one of the symptoms of their depression. The initial evaluation includes measuring a series of clinical variables and obtaining brain images with a magnetic resonance (MRI) scanner. Subjects return for two more visits, in which each participant undergoes either low-intensity focused ultrasound of connections between two areas of the brain, or a sham procedure (neither the participant nor the clinical rater know which kind of procedure occurs in each visit).
 
Immediately after low-intensity focused ultrasound or sham, the person is asked to complete questionnaires about the extent of their ruminations, and how they feel in general. We also obtain measures of cardiac and skin regulation, and another series of brain images.
 
What is the potential importance of this study?
 
The goal of the study is to define if the brain connections targeted with low-intensity focused ultrasound are the cause of rumination. This is why we need to obtain information about both the symptom itself and the brain activity. If we confirm a relationship between certain brain connections and the production of rumination, this would pave the way to a clinical trial. This trial, performed in a clinical setting, would confirm that we can actually help patients with depression to become less ruminative. For this, we could use focused ultrasound or other forms of neuromodulation. The most important thing is characterizing the brain region involved in the symptom, rather than which tool we use to alter its function.
 
Are you looking for participants? If so, who is the ideal candidate?
 
Yes, we are actively recruiting participants. This is a pilot study, meaning we plan to recruit a relatively small number of participants. Currently, there are just 20 slots remaining. Any person with active depression who is not pregnant or actively using drugs, and who can be scanned, is eligible to participate.

Persons who either very ruminative or not ruminative are eligible, as we need to know if there is a difference between the two. A small proportion of those 20 slots will be reserved for persons with no known psychiatric conditions, so healthy adults are also eligible to participate.
 
What does participation in the study involve? And will I be paid?
 
The study consists of a total of five visits. Visit 1 is for clinical evaluation and brain images. Visits 2 and 4, which occur about two weeks apart, are for assessing the effect of low-intensity focused ultrasound in comparison with sham stimulation. Between those visits, Visit 3 is short and basically used to see how the participant is doing after the first treatment (be it active or sham). Visit 5 is an opportunity to wrap up the study, in which we again check on the general mental status and brain structure. All participants will be paid for their time spent in the study.

The 2022 Laureate Institute for Brain Research (LIBR) Annual Report is now available to download via the link below. The report provides an overview of last year’s happenings at LIBR, including a letter from the President and Scientific Director, Dr. Martin Paulus, information on our mission, history and specific aims, current areas of research, funding sources, events and lectures, awards, individual laboratories, select publications and opportunities to participate in research. We hope you enjoy the publication and look forward to continuing our goal to improve mental health through neuroscience in 2023 and beyond. ​

The Oklahoman has published a op-ed piece from Dr. Martin Paulus, Sahib Khalsa and Salvador Guinjoan on what Oklahomans should consider from the latest marijuana research ahead of SQ 820.

Dr. Sahib Khalsa, M.D., Ph.D., is Director of Clinical Operations for LIBR, Associate Professor at the Oxley College of Health Sciences at the University of Tulsa, Director at LIBR Float Clinic and Research Center, and Volunteer Faculty Member in the Department of Psychiatry at the University of Oklahoma. Dr. Khalsa’s laboratory studies the role of the brain-body connection in human health; he has published more than 90 peer-reviewed papers and has received research funding from the National Institute of Mental Health (NIMH), National Institute for General Medical Sciences (NIGMS), National Center for Complementary and Integrative Health (NCCIH), the NIH/National Center for Advancing Translational Science (NCATS), the Mind and Life Foundation, and the Brain and Behavior Research Foundation. His research is currently funded by NIMH and LIBR.
 
Q: The Laureate Psychiatric Hospital and LIBR are known and respected for their work in the fields of identifying, treating, and researching eating disorders like anorexia nervosa; as February is focused on heart health, how does what you study relate to a healthy heart?

A: Many people know about the relaxing experience of floating in water or the value of taking some time each day to pause and be away from the usual hustle and bustle of daily activities. We are currently studying the potential therapeutic impact of a particular form of Reduced Environmental Stimulation Therapy (REST) called Floatation-REST, on mental health in individuals with anxiety disorders, depression, eating disorders, or substance use disorder. Floatation-REST reduces external sensory input to the central nervous system by minimizing environmental stimulation, through the act of floating supine in a pool of water saturated with Epsom salt. In this environment, the density of the salt water allows for effortless floating. The temperature of the air and water is matched to the person’s skin temperature, and visual and auditory stimulation and movement is minimized.
​
Our research using Floatation-REST (Paper 1) (Paper 2) has shown that it can significantly reduce blood pressure during the float session, especially the diastolic blood pressure, reduce breathing rate, and certain metrics of heart rate variability, suggesting a shift in the autonomic nervous system toward a more relaxed state. Interestingly, Floatation-REST is also associated with enhanced awareness for cardiac and respiratory sensations while reducing anxiety levels in anxious individuals, indicating a paradoxical effect. We have also recently found that Floatation-REST acutely lowers anxiety and stress symptoms and improves some aspects of body image in hospitalized individuals with anorexia nervosa.
 
Q: How do your present studies take the next steps in studying heart health as it relates to eating disorders?

A: Our ongoing studies are adding to the rigor of prior research by thoroughly characterizing the cardiovascular changes induced by Floatation-REST and examining how neural and physiological changes are associated with its anxiolytic effects. For example, in healthy individuals, we have found that Floatation-REST is associated with a reduced functional coupling of brain activity within the hubs of brain networks most responsible for creating and mapping our sense of self. We also recently found that women with anorexia nervosa show reduced brain-body network connectivity after undergoing a cardiac stress challenge; the less connected these parts of the brain were, the more anxiety, depression, and negative body image the women had.  We plan to extend these studies to identify whether changes in similar brain networks helps to explain the beneficial impacts observed with Floatation-REST in individuals with eating disorders. 
 
Q: Do you need people to help you with this new research project?

A: We are conducting several studies looking at the role of the brain-body connection in eating disorders. When an individual receiving treatment with Laureate qualifies for ongoing research studies, they may be offered the opportunity to participate. The clinical team assists in evaluating how participation will support their recovery and whether the individual might benefit from engaging in the study.  We also need volunteers not in treatment for an eating disorder to help with this research. If you or someone you know between the ages of 13-40 would like to be one of our paid volunteers, please contact our lab or fill out the form on our website.