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Oliver Robinson is a Professor of Neuroscience and Mental Health at the Institute of Cognitive Neuroscience. He’s never been more excited about the work his team are conducting at the Anxiety Lab.
It may seem a little peculiar, but if you walk in on one of the studies being conducted by the Anxiety Lab, you might see participants watching an edge-of-your-seat thriller film. It is just one way Professor Oliver Robinson and his team are using simulated scenarios, combined with neuroimaging, to understand what happens to the brain in an anxious state.
“Rather than have people do constrained cognitive tests, which obviously have their advantages but aren't terribly good at eliciting emotions, we can essentially steal from Hollywood and make these very effective stimuli that make people anxious or happy or sad,” says Robinson.
“Movies are closer to the real world. So I think an exciting development in neuroimaging is showing people movies in scanners and trying to understand what's happening in their brains.”
Robinson does admit however, that scary movies are most certainly not his thing.
Anxiety is the most prevalent mental health condition in the UK, with over 8 million people experiencing an anxiety disorder at any one time, according to Mental Health UK.
And yet, defining it is not so simple. Particularly when it comes to delineating between anxiety and fear.
“We have a working, operational definition of anxiety, which is: the response to unpredictable, long and unclear negative stimuli,” Robinson says.
"Whereas fear is a response to a predictable, knowable, specific negative stimulus.”
Robinson and his lab focus primarily on pathological anxiety.
“It's a normal, healthy function to be able to process bad things, whether they're predictable responses or unpredictable anxiety responses. Everyone has these emotions and they're useful. But when it becomes pathological, it's when these experiences and emotions get in the way of your daily life.”
Despite the prevalence of anxiety disorders in society, when it comes to treatments, there is significant progress to be made.
“We have pharmacological treatments that work for something like a third of people,” Robinson says. “We've got psychological treatments that work for, depending on who it is, close to 50% of people. And when you put those two things together, you're probably getting to a point where up to three quarters of people will have some kind of treatment that works for them. But we don't know who will respond to treatment X and who will respond to treatment Y.”
“So, invariably, people will spend many years, if not decades, trying different things before they find something that works.”
But perhaps an even more pressing concern is the remaining percentage of anxiety sufferers who don’t respond to either treatment.
“For a quarter to a third of people, nothing works for them at all."
This presents a huge unmet burden that Robinson and his team are working to address. They bring modern advances in neuroscience to address gaps in mental health treatment.
One such advancement is computational psychiatry, which has become a staple of the Anxiety Lab’s work.
“Computational psychiatry is applying the tools of computer science and mathematics to understanding how the brain implements behavior. By combining behavioural measures that we use in computational psychiatry with brain neuroimaging, we’ll eventually be able to map not only the processes that lead to symptoms (of anxiety), but also where that’s coming from in the brain.”
“It's been happening here at UCL certainly for as long as I've been here. It's now becoming very popular and it's happening all over the world, but UCL is really where it got started.”
Oliver and members of the Anxiety Lab and the bigger Neuroscience and Mental Health group at their Christmas event in 2022.
Robinson is also excited about another study reaching its conclusion. After nearly eight years of data collection, including a pandemic in the middle, the lab have just finished a large-scale study investigating the effectiveness of the common anxiety medication escitalopram, which is a Selective Serotonin Reuptake Inhibitor (SSRIs).
“We're only just getting the results in, but we will have, within the next few months, some exciting findings telling us what's going on in the brain when people are taking these kind of anti-anxiety medications."
“And that ties in with a study that we have ongoing at the moment, using everything exactly the same, but looking at psychological therapy. So in about two years time, we'll be able to compare antidepressant and anxiety medication with psychological therapy, and what's happening in the brain before and after treatment.”
In other areas of medicine, clear causal pathways exist between cell and symptom, but in studies of mental health this can be far less transparent.
“We really have bits and pieces - there's not a joined up picture,” Robinson says.
“We (The Anxiety Lab) exist to try to join that together and then try to use that understanding to develop and inform new treatments down the line.”