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Providence VA Medical Center, Rhode Island


Focus Area 2

 Restoring Affective and Cognitive Health

 Director: Noah Philip, MD

Core Investigators:
Benjamin Greenberg, MD, PhD
M.Tracie Shea, PhD

Led by Dr. Philip, FA-2 aims to use noninvasive neurotechnologies to understand and change abnormal brain circuit functioning in a group of neurobehavioral disorders that impose major health and functional burdens on Veterans. These include post-traumatic stress disorder (PTSD), depression, chronic pain, and obsessive-compulsive disorder (OCD). The interventional technologies deliver brain stimulation through devices placed on the scalp to affect the underlying brain. Specifically, we use transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (using DC current: tDCS or alternation current: tACS). To map brain circuit function in these conditions we use advanced MRI methods in collaboration with Core A. In the past year we have increasingly incorporated electrophysiology (EEG) in this research, in close collaboration with Core B.
Examples of FA-2 research include:
PTSD. Effective behavioral therapies for PTSD are thought to rely on fear extinction; CfNN-supported research suggests that tDCS targeting relevant brain circuitry enhances the extinction of conditioned fear in healthy individuals (Van't Wout et al., 2016).

Depression. CfNN’s ongoing work on therapeutic TMS in depression + PTSD suggests that a lower frequency (5Hz) TMS regimen is therapeutically effective. New mechanistic research led by Dr. Philip and supported by his CDA2 and CfNN suggests that the antidepressant response to TMS can in part be predicted by specific patterns in brain network connectivity before treatment.
Pain. This line of CfNN research has complementary directions: 1) studies of the emotional (affective) component of chronic pain, a clinical feature which magnifies pain-related disability, and 2) studies of acute pain-related distress and how brain mechanisms relate to the ability to direct attention away from acute or chronic pain perception. A published preliminary study, led by a CfNN-associated psychiatry resident trainee, suggested that acute tDCS targeting dorsal anterior cingulate cortex might improve the ability to tolerate distress related to pain (Mariano et al., 2015).
OCD. CfNN investigators completed 12-month data collection in a multicenter NIH-supported trial of deep brain stimulation for individuals suffering with intractable illness (Greenberg, PI). Data analysis in collaboration with Dr. Richard Jones (CfNN Core C) is underway.