Using Digital Neurotherapy to Address Depression and Anxiety in Patients with Cancer

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the latest
00:12 --> 00:14information on cancer care by welcoming
00:14 --> 00:17oncologists and specialists who are on the
00:17 --> 00:19forefront of the battle to fight cancer.
00:19 --> 00:21This week it's a conversation about
00:21 --> 00:23the use of digital neurotherapy to
00:23 --> 00:26address anxiety and depression in cancer
00:26 --> 00:28patients with Doctor Bruce Wexler.
00:28 --> 00:30Doctor Wexler is a professor emeritus
00:30 --> 00:32and senior research scientist in
00:32 --> 00:35psychiatry at the Yale School of Medicine,
00:35 --> 00:36where Doctor Chagpar is a
00:36 --> 00:38professor of surgical oncology.
00:39 --> 00:41Dr. Wexler, maybe we can start off
00:41 --> 00:43by you telling us a little bit more
00:43 --> 00:44about yourself and what it is you do.
00:46 --> 00:49Well, I'm a psychiatrist
00:49 --> 00:51and a neuroscientist.
00:51 --> 00:53I've been interested my whole
00:53 --> 00:56career in how our brains work.
00:56 --> 00:58And how our brains support and
00:58 --> 01:01what their relationship is to the
01:01 --> 01:03way we think and feel as people.
01:03 --> 01:06And then how our brains and
01:06 --> 01:08our minds together interact
01:08 --> 01:10with the rest of our bodies.
01:10 --> 01:12We're learning more and more
01:12 --> 01:13about all of these things.
01:13 --> 01:16And you can see already that I
01:16 --> 01:18don't shy away from the complexity
01:18 --> 01:21of these questions and of the way
01:21 --> 01:24these wonderful parts of us are
01:24 --> 01:26actually organized and work.
01:26 --> 01:27Our brains,
01:27 --> 01:29as you may know have over 80
01:29 --> 01:31billion neurons and each one can
01:31 --> 01:32be connected to 1000 other ones.
01:32 --> 01:35It's the most complex living
01:35 --> 01:37system that we know about,
01:37 --> 01:39and I'm a systems thinker and I'm
01:39 --> 01:41happy to explain what that means
01:41 --> 01:43and how we relate it to how the
01:43 --> 01:45brain works and our minds work.
01:45 --> 01:47And then issues like depression,
01:47 --> 01:50anxiety, and physical illness.
01:51 --> 01:53Yeah, so tell us more about what
01:53 --> 01:55exactly a systems thinker is
01:55 --> 01:58and how it applies.
01:58 --> 02:02The systems thinker likes to look at and
02:02 --> 02:05appreciates the necessity of understanding
02:05 --> 02:07the complexity of how things interact,
02:07 --> 02:10And a key concept in these is
02:10 --> 02:12called an emergent property.
02:12 --> 02:15An emergenet property is something that comes
02:15 --> 02:18into existence when different parts interact.
02:18 --> 02:19But doesn't exist in
02:19 --> 02:21either one by themselves.
02:21 --> 02:23Like water, for example.
02:23 --> 02:25Water has all these wonderful
02:25 --> 02:27properties of freezing and expanding
02:27 --> 02:30and creating crystals, forming snow,
02:30 --> 02:33flowing in water in streams and rivers.
02:33 --> 02:34So you might say,
02:34 --> 02:36a scientist might say, well,
02:36 --> 02:38I want to understand where this comes from.
02:38 --> 02:40It's made-up of two atoms of
02:40 --> 02:42hydrogen and one of oxygen.
02:42 --> 02:44Let's break it apart and look at
02:44 --> 02:46the hydrogen and look at the oxygen
02:46 --> 02:48so we can understand where all these
02:48 --> 02:50properties come from. The water,
02:50 --> 02:51when you break it apart,
02:51 --> 02:52those properties disappear.
02:52 --> 02:55They don't exist in hydrogen and oxygen,
02:55 --> 02:58only in their special combination.
02:58 --> 03:00So apply that to what I told
03:00 --> 03:01you about our brain.
03:01 --> 03:0380 billion neurons and each one
03:03 --> 03:05connected to a 1000 others.
03:05 --> 03:08This is a complex system
03:08 --> 03:10of interacting parts,
03:10 --> 03:12and it's those interactions that
03:12 --> 03:14create the emergent processes and
03:14 --> 03:15among those emergent processes
03:15 --> 03:18are the way we think and feel.
03:18 --> 03:19Because our brain is
03:19 --> 03:20organized hierarchically,
03:20 --> 03:23from single cells, to two cells,
03:23 --> 03:26dyads that work together to local
03:26 --> 03:28neurons that create little microcircuits,
03:28 --> 03:30to neurosystems that integrate
03:30 --> 03:32hundreds of millions of neurons
03:32 --> 03:34from all across the brain.
03:34 --> 03:36And cognition and emotion live
03:36 --> 03:38there at the neurosystems level,
03:38 --> 03:41not in individual cells.
03:41 --> 03:43So as a psychiatrist,
03:43 --> 03:46I'm interested in how people
03:46 --> 03:48think and feel and what
03:48 --> 03:49could cause disturbances,
03:49 --> 03:50subjective discomfort in
03:50 --> 03:53the way we think and feel.
03:53 --> 03:55So that means that these are disruptions
03:55 --> 03:57and changes in their systems,
03:57 --> 03:59not at the sub level.
03:59 --> 04:03So a systems thinker understands emergent
04:03 --> 04:05properties, embraces the complexity.
04:05 --> 04:08It's an alternate approach to science.
04:08 --> 04:10The reduction approach has its own
04:10 --> 04:12values which it takes things apart
04:12 --> 04:14to look at the individual ones.
04:14 --> 04:16The systems part puts them together
04:16 --> 04:18and then says what happens when
04:18 --> 04:20you put them together in more and
04:20 --> 04:21more complex and in our brains,
04:21 --> 04:24dynamic ways that reconfigure
04:24 --> 04:25themselves constantly.
04:25 --> 04:27Then we put the brain in the context
04:27 --> 04:29of the body and we're learning more
04:29 --> 04:31about how the brain affects the body.
04:31 --> 04:34The mind affects other parts
04:34 --> 04:35of brain function,
04:35 --> 04:36the neurosystems affect other
04:36 --> 04:38parts of brain function,
04:38 --> 04:39how those affect the body,
04:39 --> 04:42how the body affects the brain.
04:42 --> 04:43We're learning about that,
04:43 --> 04:45for example, the microbiome,
04:45 --> 04:48all the bacteria that live in our gut,
04:48 --> 04:51in fact, the way our brains work at times.
04:51 --> 04:53And this then takes us into
04:53 --> 04:55the realm of depression,
04:55 --> 04:56anxiety,
04:56 --> 04:57psychiatric problems,
04:57 --> 05:00emotional problems and how they
05:00 --> 05:01interact with body processes
05:01 --> 05:03and in certain situations,
05:03 --> 05:05how they interact with.
05:05 --> 05:06Chronic diseases,
05:06 --> 05:08which are affecting different parts
05:08 --> 05:11of our bodies and the brain and the
05:11 --> 05:12body interact in those processes too.
05:14 --> 05:16Yeah, you know, it's it's really
05:16 --> 05:18interesting when you kind of think about
05:18 --> 05:21the brain and and the complexity that
05:21 --> 05:24it has being really the Control Center
05:24 --> 05:28for pretty much everything that our body
05:28 --> 05:30does including controlling our emotions.
05:30 --> 05:32When we think about cancer patients,
05:32 --> 05:35however, we often think that this
05:35 --> 05:38is a devastating diagnosis and that
05:38 --> 05:40that just engenders this emotion
05:40 --> 05:42of depression and anxiety.
05:42 --> 05:46For for many patients who are facing this,
05:46 --> 05:46this diagnosis,
05:46 --> 05:50rarely do we actually think about, well,
05:50 --> 05:53how does that work at a neuron level?
05:53 --> 05:56So tell us more about how exactly that does
05:56 --> 05:59work and what are the implications because.
06:00 --> 06:02If this is just a matter of,
06:02 --> 06:05you know, how neurons interact,
06:05 --> 06:06well, maybe there's something that
06:06 --> 06:08we can do about that.
06:09 --> 06:11Absolutely, That's absolutely right.
06:14 --> 06:16So we know, First off to start with,
06:16 --> 06:19that different people react to different
06:19 --> 06:21life experiences in different ways and
06:21 --> 06:24those reactions may facilitate dealing
06:24 --> 06:27with the life situation, whether it be a.
06:27 --> 06:29Emotional work challenge or whether
06:29 --> 06:32it be a health challenge like cancer.
06:32 --> 06:35Or they could act aggravate the problems.
06:35 --> 06:39So we understand then that at this neuro
06:39 --> 06:42systems level we are reacting to processing,
06:42 --> 06:45regulating our emotions,
06:45 --> 06:47processing information and figuring
06:47 --> 06:49out just how am I going to respond
06:49 --> 06:50to that as a person who I am,
06:50 --> 06:52how am I going to deal with that?
06:52 --> 06:55And we know from studies that.
06:55 --> 06:58Many patients with cancer feel that
06:58 --> 07:01their depression compromises a recovery,
07:01 --> 07:03and many oncologists believe that
07:03 --> 07:05and there's data to support it.
07:05 --> 07:08So that's an example.
07:08 --> 07:10Depression in studies of people
07:10 --> 07:13with cancer have shown that the
07:13 --> 07:17presence of depression can compromise
07:17 --> 07:18survival significantly.
07:18 --> 07:21So right there we have multiple
07:21 --> 07:23reasons for wanting to.
07:23 --> 07:25Consider the options of how somebody
07:25 --> 07:28when faced with this real challenge,
07:28 --> 07:28as you say,
07:28 --> 07:31and these this threat to them as a person.
07:31 --> 07:33The complications of their lives,
07:33 --> 07:35the changes and the losses that
07:35 --> 07:36people experience in terms of the
07:36 --> 07:38type of activities that they can
07:38 --> 07:40do in the discomfort of involving
07:40 --> 07:42being involved in the treatments
07:42 --> 07:44and the anxiety about the outcomes.
07:44 --> 07:49And so many things change the way
07:49 --> 07:50people deal with that can make
07:50 --> 07:52a difference in the outcome.
07:52 --> 07:54And one of the ways that we label
07:54 --> 07:56differences in the way people may
07:56 --> 07:58deal with it is how anxious are
07:58 --> 08:00they or how depressed are they.
08:00 --> 08:02And so that becomes some place that
08:02 --> 08:04we can help people and intervene.
08:04 --> 08:07And digital neurotherapy is a new
08:07 --> 08:10type of intervention that's been
08:10 --> 08:12proven to reduce depression without
08:12 --> 08:14medication and without any side effects.
08:17 --> 08:19So I mean it certainly
08:19 --> 08:20makes sense that those who.
08:20 --> 08:22May suffer from depression.
08:22 --> 08:24May have worse survivals.
08:24 --> 08:26I mean, because certainly it may not
08:26 --> 08:28be the depression in and of itself,
08:28 --> 08:30but the effects of that depression.
08:30 --> 08:32Too depressed to get out of bed.
08:32 --> 08:34I'm too depressed to take my medicine.
08:34 --> 08:36I'm too depressed to go to the doctor.
08:36 --> 08:39I'm too depressed to do much of anything.
08:39 --> 08:42And so that has ramifications.
08:42 --> 08:44But tell us more about digital neurotherapy.
08:44 --> 08:46I'm not certain that many of our
08:46 --> 08:47listeners know what that is.
08:48 --> 08:50They probably don't because it's a new class,
08:50 --> 08:53a new type of treatment of CNS or brain
08:53 --> 08:55disorders and emotional disorders.
08:55 --> 08:57And you're absolutely right about the
08:57 --> 08:58things you say that the mechanisms
08:58 --> 09:00on the behavioral level that we can
09:00 --> 09:02understand how cancer might a depression,
09:02 --> 09:05I'm sorry, might impact.
09:05 --> 09:07Health and survival in cancer patients
09:07 --> 09:10and other patients with other medical
09:10 --> 09:12diseases because it's just as big
09:12 --> 09:14an impact in cardiovascular disease
09:14 --> 09:16or diabetes addition might to the
09:16 --> 09:19things you listed in these patients,
09:19 --> 09:21people might exercise less,
09:21 --> 09:23might have less social contact in
09:23 --> 09:25the social world, supports us,
09:25 --> 09:26might have compromised immune
09:26 --> 09:27system function.
09:27 --> 09:29So those are some just to add to your
09:29 --> 09:32list of our understanding of the mechanisms,
09:32 --> 09:35but what is digital neurotherapy?
09:35 --> 09:38So remember I said that it is these
09:38 --> 09:40neuro systems that integrate action
09:40 --> 09:43of a hundreds of millions of neurons
09:43 --> 09:45that are are the place where we are
09:45 --> 09:48emotions arise from and are also our
09:48 --> 09:50cognitive abilities and our ability
09:50 --> 09:53to regulate emotion to a set of these
09:53 --> 09:54functions are called executive cognitive
09:54 --> 09:57functions that are defined as those
09:57 --> 10:00that are cognitive functions important for.
10:00 --> 10:01Regulating and managing ourselves
10:01 --> 10:03and our feelings and information
10:03 --> 10:05from the environment.
10:05 --> 10:07So that is is, is,
10:07 --> 10:10is a target that we'd like to
10:10 --> 10:12enhance those particular functions.
10:12 --> 10:12Now,
10:12 --> 10:15we also know from work done in the
10:15 --> 10:191950s that in after birth is when
10:19 --> 10:20these neuro systems are shaped
10:20 --> 10:23not by our genetics primarily,
10:23 --> 10:25but by experience from the environment.
10:25 --> 10:27Hubel and Weisel got the Nobel
10:27 --> 10:28Prize for showing the.
10:28 --> 10:31Degree to which our frames are
10:31 --> 10:32shaped structure and function
10:32 --> 10:35these neurosystems after birth by
10:35 --> 10:36stimulation from the environment.
10:36 --> 10:38Now how does their digital
10:38 --> 10:40neurotherapy fit into that?
10:40 --> 10:42Imagine if you're going around
10:42 --> 10:44the corner and you're trying to
10:44 --> 10:46decide if it's a bear or a delivery
10:46 --> 10:47truck coming at you.
10:48 --> 10:51The only information you have is the
10:51 --> 10:53pattern in the light waves coming to your
10:53 --> 10:56eye that are reflected off the object.
10:56 --> 10:56We may think, oh,
10:56 --> 10:58I'm going to figure this out.
10:58 --> 10:59Let me look at it this way.
10:59 --> 11:00What could that be?
11:00 --> 11:02The only information,
11:02 --> 11:05the only data coming into your brain is a
11:05 --> 11:07pattern of light waves coming into your eye.
11:07 --> 11:10Now, if it's a bear or a delivery truck,
11:10 --> 11:13it activates very different neural systems,
11:13 --> 11:13right?
11:13 --> 11:15Different feelings,
11:15 --> 11:16different behaviors.
11:16 --> 11:17So digital neurotherapy,
11:17 --> 11:20we use the eyes and ears to
11:20 --> 11:23physically interact with the brain.
11:23 --> 11:26But we have much more precise control
11:26 --> 11:28and smaller differences between whether
11:28 --> 11:31it's a bear or a delivery truck.
11:31 --> 11:33So Digital Neuro Therapy looks
11:33 --> 11:35like a computer game,
11:35 --> 11:39but it's actually carefully crafted,
11:39 --> 11:43incrementally changing challenges,
11:43 --> 11:46perceptual and cognitive processing
11:46 --> 11:49that each one activates a
11:49 --> 11:51slightly different neuro system.
11:51 --> 11:53So why is this applicable to depression?
11:53 --> 11:54Well,
11:54 --> 11:56depression itself now is understood
11:56 --> 11:58as a neurosystems disorder.
11:58 --> 12:01The frontal executive systems of
12:01 --> 12:04the brain that regulate emotion,
12:04 --> 12:08regulate negative feelings are impaired,
12:08 --> 12:10and the negative feeling parts
12:10 --> 12:12of the brain start to
12:12 --> 12:14actually overwhelm these executive
12:14 --> 12:16control systems. And then.
12:16 --> 12:19It gets worse and worse because there's more
12:19 --> 12:22and more dysregulation of the emotion part.
12:22 --> 12:25So we can actually strengthen those
12:25 --> 12:28frontal executive control systems
12:28 --> 12:31by exercising them the same what
12:31 --> 12:33we call active activity dependent
12:33 --> 12:35enhancement of the neural systems.
12:35 --> 12:37That's the same thing that
12:37 --> 12:38shaped them at the beginning.
12:38 --> 12:41That's how our brains evolved so wonderfully
12:41 --> 12:43to be responsive to our environments.
12:43 --> 12:46So we harness that neuroplastic
12:46 --> 12:49potential using the eyes and ears and
12:49 --> 12:53input as input pathways and present
12:53 --> 12:56very carefully crafted incrementally
12:56 --> 12:58changing cognitive and perceptual tasks.
12:58 --> 13:01And those then activate the parts
13:01 --> 13:03of the brain and that that we need
13:03 --> 13:05to target to strengthen and when
13:05 --> 13:07they're activated that produces
13:07 --> 13:09activity dependent enhancement.
13:09 --> 13:11Now we've demonstrated this
13:11 --> 13:12with brain imaging.
13:12 --> 13:14That we are actually
13:14 --> 13:15changing brain activation.
13:15 --> 13:17We've demonstrated in depression
13:17 --> 13:18they were actually changing
13:18 --> 13:20the connectivity in the brain
13:20 --> 13:22that creates the neuro systems.
13:22 --> 13:24And we've demonstrated in multiple
13:24 --> 13:27published studies now in the top journals
13:27 --> 13:30that this type of intervention reduces
13:30 --> 13:33depressed mood more effectively than
13:33 --> 13:35medicine and also improves cognition
13:35 --> 13:38is a side benefit by the way for
13:38 --> 13:41people with cancer because sometimes.
13:41 --> 13:43The treatments for cancer can compromise.
13:43 --> 13:45As we know called chemo brain are
13:45 --> 13:47thinking and cognitive functions.
13:47 --> 13:49So we're enhancing those at the same
13:49 --> 13:51time with digital neuro therapy.
13:51 --> 13:53So it looks like a computer game,
13:53 --> 13:55but it's crafted the way I said to
13:55 --> 13:57harness the brains neuro potential,
13:57 --> 13:58neuroplastic potential to
13:58 --> 14:00enhance under functioning neuro
14:00 --> 14:02systems that regulate emotion.
14:03 --> 14:05Wow, that sounds really,
14:05 --> 14:06really interesting,
14:06 --> 14:09but we're going to pick up this
14:09 --> 14:11conversation and learn more about.
14:11 --> 14:12Digital Neurotherapy and how it
14:12 --> 14:14can be used to address depression
14:14 --> 14:16and anxiety right after we take a
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15:27 --> 15:29You're listening to Connecticut Public Radio.
15:31 --> 15:33Welcome back to Yale Cancer Answers.
15:33 --> 15:34This is Doctor Anees Chagpar,
15:34 --> 15:36and I'm joined tonight by my guest,
15:36 --> 15:38Doctor Bruce Wexler.
15:38 --> 15:40We're talking about ways to address
15:40 --> 15:43depression and anxiety in cancer
15:43 --> 15:45patients using digital neurotherapy.
15:45 --> 15:47So before the break, Doctor Wexler,
15:47 --> 15:49you were telling us that this
15:49 --> 15:51looks like a computer game,
15:51 --> 15:55but it's carefully crafted so that it
15:55 --> 15:58actually exercises or strengthens executive.
15:58 --> 16:01Portions of your brain that
16:01 --> 16:04are underutilized so that you
16:04 --> 16:07actually can improve the manner in
16:07 --> 16:10which you respond to a stressful
16:10 --> 16:12or emotional stimulus and can
16:12 --> 16:14improve your cognition as well.
16:14 --> 16:15Is that right?
16:15 --> 16:17That's absolutely right. Yeah.
16:17 --> 16:20So a couple of questions.
16:20 --> 16:24First off, it sounds like this would be
16:24 --> 16:28something that people should be doing.
16:28 --> 16:32Lifelong Why wait until they get cancer to
16:32 --> 16:35start exercising this part of the brain?
16:35 --> 16:37Is there a right time to start
16:37 --> 16:39using digital neurotherapy?
16:39 --> 16:40And it doesn't really need
16:40 --> 16:41to be a neurotherapy?
16:42 --> 16:44Or could it actually be, you know,
16:44 --> 16:47a downloadable app that you can play with
16:47 --> 16:49if it truly is like a computer game,
16:49 --> 16:51But that just has the side benefit
16:51 --> 16:53of making your brain stronger.
16:54 --> 16:55Great questions.
16:55 --> 16:57It is a downloadable app.
16:57 --> 16:59That's exactly what it's used and
16:59 --> 17:00it's available for people to use.
17:00 --> 17:03Now. Now, who should use it,
17:03 --> 17:06when they should use it and why they
17:06 --> 17:08should use it are really key questions.
17:08 --> 17:11If we step back from a therapy
17:11 --> 17:13perspective and say, well,
17:13 --> 17:15what about all these processes of how
17:15 --> 17:18our brains are shaped by the environment
17:18 --> 17:21and strengthening our ability to manage
17:21 --> 17:23ourselves and manage our emotions,
17:23 --> 17:25that's what we do.
17:25 --> 17:27In schools, that's what we do in growing up.
17:27 --> 17:29That's what we do in
17:29 --> 17:30processing life experience,
17:30 --> 17:33and that's what we do with the input
17:33 --> 17:35that's coming into us all the time.
17:35 --> 17:36It's shaping our brains.
17:36 --> 17:38Every night they get reshaped.
17:38 --> 17:39So this happens.
17:39 --> 17:42Why would we want to do something
17:42 --> 17:46more specific to focus it? Well,
17:46 --> 17:48we already make big attempts with education,
17:48 --> 17:50for example, right?
17:50 --> 17:51A major feature.
17:51 --> 17:53Of modern societies or schools
17:53 --> 17:57where we put together a certain type
17:57 --> 17:59of expertise and curriculum and
17:59 --> 18:02activities specifically to shape
18:02 --> 18:07the brain in the neuroplastic change
18:07 --> 18:10period when their brain is being
18:10 --> 18:12really actively shaped in childhood.
18:12 --> 18:14So in this we actually have a
18:14 --> 18:16whole program for schools and
18:16 --> 18:18we and why in schools?
18:18 --> 18:21Why not just let the curriculum do its job.
18:21 --> 18:22Well,
18:22 --> 18:24there we specifically addressing
18:24 --> 18:27achievement gaps related to poverty
18:27 --> 18:29because they are the children just
18:29 --> 18:31haven't had the experiences that
18:31 --> 18:33they need to promote development of
18:33 --> 18:35these neuro systems and in fact have
18:35 --> 18:37some bad type of experiences that
18:37 --> 18:39actually compromise the development
18:39 --> 18:41of the executive functional systems.
18:41 --> 18:43So there I call it a school
18:43 --> 18:45lunch program for the brain,
18:45 --> 18:47just like we give children
18:47 --> 18:49from less ideal backgrounds.
18:49 --> 18:51Additional food in school,
18:51 --> 18:54they actually then grow faster and
18:54 --> 18:56and reach their growth potential.
18:56 --> 18:57Same thing with this.
18:57 --> 18:59So you hear,
18:59 --> 19:01you see we're addressing a a problem
19:01 --> 19:02that can build on itself, right?
19:02 --> 19:04Because the children then don't
19:04 --> 19:06aren't prepared to no fault of
19:06 --> 19:08their own neurologically to meet
19:08 --> 19:10the demands made of them in school.
19:10 --> 19:13And this sets off a problematic
19:13 --> 19:15development developmental trajectory.
19:15 --> 19:16Affecting how they think and
19:16 --> 19:17feel about themselves,
19:17 --> 19:19how they engage with the school curriculum.
19:19 --> 19:21They lose the second time they come
19:21 --> 19:24to school where they're supposed to be
19:24 --> 19:25getting this educational enrichment,
19:25 --> 19:27they can't engage with it.
19:27 --> 19:29And so that's the type of
19:29 --> 19:31situation where you would say,
19:31 --> 19:31yeah,
19:31 --> 19:33well there is when we really need this
19:33 --> 19:37sort of intervention now in certain.
19:37 --> 19:39For a variety of reasons,
19:39 --> 19:41and I'm speaking as a psychiatrist
19:41 --> 19:43for a variety of reasons which
19:43 --> 19:45have to do with cascading effects
19:45 --> 19:47of life experiences and stresses,
19:47 --> 19:48genetic predispositions.
19:48 --> 19:52Our brains all start off in different ways.
19:52 --> 19:54Some people develop their brain
19:54 --> 19:56systems in certain ways that
19:56 --> 19:58have limitations and problems,
19:58 --> 20:00and they seek help for that.
20:00 --> 20:03It could be seeing a psychiatrist
20:03 --> 20:05for a talk therapy that can help
20:05 --> 20:07restructure those neuro systems.
20:07 --> 20:10Because you're feel very sensitive,
20:10 --> 20:12say to rejection or you don't have a
20:12 --> 20:14confidence in nothing yourself
20:14 --> 20:16because of the way certain things
20:16 --> 20:18happen to you and the way your brain
20:18 --> 20:20responds to them at that point.
20:20 --> 20:22So then we're talking about a corrective,
20:22 --> 20:24deliberate intervention, right,
20:24 --> 20:28to help reshape the neurosystems.
20:28 --> 20:29So for depressed patients,
20:29 --> 20:33we have a lot of data quite
20:33 --> 20:37independently independent of.
20:37 --> 20:39Any medical condition that may be related
20:39 --> 20:42to the depression that we can enhance.
20:42 --> 20:43As you said,
20:43 --> 20:46these neuro systems that support
20:46 --> 20:48the executive control systems that
20:48 --> 20:51regulate emotion now having a chronic
20:51 --> 20:55medical disease happens to be one of
20:55 --> 20:57the type of life experiences that
20:57 --> 20:59your listeners know all too well.
20:59 --> 21:02Many of them compromise your ability to
21:02 --> 21:05relate to the environment that sustains us.
21:05 --> 21:07We're so connected to the environments.
21:07 --> 21:09I didn't have time to fully explain that.
21:09 --> 21:11I developed more fully of all these
21:11 --> 21:14dimensions and in a book I wrote.
21:14 --> 21:16But I I don't have time now to go into
21:16 --> 21:18all the ways that we need to stay
21:18 --> 21:20connected to these environmental inputs
21:20 --> 21:22that shaped us, to also sustain us.
21:22 --> 21:25That's why the COVID isolations were
21:25 --> 21:27so hard for so many people who wanted,
21:27 --> 21:28you know,
21:28 --> 21:31to go back to my pub or my haircut salon.
21:31 --> 21:32That's my life.
21:32 --> 21:34That's part of me.
21:34 --> 21:36And so all that gets disrupted by
21:36 --> 21:38a chronic illness and then there's
21:38 --> 21:42more stress put on these key neuro
21:42 --> 21:44systems and they can then become
21:44 --> 21:47compromised in the way I said.
21:47 --> 21:50And so this becomes another type of
21:50 --> 21:52situation right there where we would
21:52 --> 21:54say we want a special intervention.
21:54 --> 21:56So in answer to your question,
21:56 --> 21:57there are,
21:57 --> 21:59there is our brains are continually shaped.
21:59 --> 22:01We need to be connected to the right type.
22:01 --> 22:03Of input from our environments.
22:03 --> 22:04Hopefully that largely happens from
22:04 --> 22:07the way we as a society have created
22:07 --> 22:10those environments and we relate to
22:10 --> 22:12other people and that goes along nicely.
22:12 --> 22:14There are times of course when
22:14 --> 22:14the environment,
22:14 --> 22:17as we see in the troubled places
22:17 --> 22:19around the world where violence
22:19 --> 22:20is totally disrupted,
22:20 --> 22:22the community and the lives and the
22:22 --> 22:24type of stimulation that's coming
22:24 --> 22:26into those people's brains and minds,
22:26 --> 22:28that's really distorting them
22:28 --> 22:30in ways that are have lifelong.
22:30 --> 22:31Consequences.
22:31 --> 22:34So the time when you ask, should
22:34 --> 22:36everybody be doing this all their lives?
22:36 --> 22:38Well, yes, we are.
22:38 --> 22:40We're doing it through established
22:40 --> 22:42social structures of reading books,
22:42 --> 22:44listening to music,
22:44 --> 22:45going to school,
22:45 --> 22:47interacting with other people.
22:47 --> 22:49But there are special times when we
22:49 --> 22:51want a special type of intervention.
22:52 --> 22:56So let me kind of nail that down a little
22:56 --> 22:59bit, you know, when we think about.
22:59 --> 23:01Cancer patients, not only have they
23:01 --> 23:04now been given this devastating
23:04 --> 23:08diagnosis which routinely never puts
23:08 --> 23:10an appointment invite on your calendar.
23:10 --> 23:13So it it is often unexpected and
23:13 --> 23:17you are now thrust into this life
23:17 --> 23:20changing experience dealing with not
23:20 --> 23:24only the physical ailment but also.
23:24 --> 23:25You know, how is this going to
23:25 --> 23:27affect your family, your children,
23:27 --> 23:30your job, the financial toxicity,
23:30 --> 23:32losing your hair, your body image,
23:32 --> 23:34and on and on and on and on.
23:34 --> 23:38You have a myriad of doctor's
23:38 --> 23:40appointments and diagnostic tests.
23:40 --> 23:42So a couple of questions.
23:42 --> 23:45While the digital digital neurotherapy
23:45 --> 23:48sounds like it would be advantageous,
23:48 --> 23:52particularly for your emotional health.
23:52 --> 23:53Two questions.
23:53 --> 23:57One, how does that fit into this incredible
23:57 --> 24:00whirlwind that you're already in?
24:00 --> 24:03Would that increase anxiety and
24:03 --> 24:06and depression by being yet another
24:06 --> 24:08thing I need to do?
24:08 --> 24:10And #2,
24:10 --> 24:14in terms of rewiring or reshaping
24:14 --> 24:17or strengthening the the brain
24:17 --> 24:19and the cognitive processes,
24:19 --> 24:21does that take time?
24:21 --> 24:23Because certainly with cancer it's
24:23 --> 24:25gonna move at its own pace.
24:25 --> 24:28And are we playing catch up at that point?
24:30 --> 24:34These are again, great questions.
24:34 --> 24:37I know there's a big burden of the
24:37 --> 24:39illness and also of the treatments.
24:39 --> 24:41The nice thing about the digital
24:41 --> 24:43neuro therapy is that you
24:43 --> 24:44do it when you want at home.
24:44 --> 24:45And so for example,
24:45 --> 24:48if you logged on to the Ch Sciences website,
24:48 --> 24:51which is a Yale startup company
24:51 --> 24:53that's tried to is bringing the dirt,
24:53 --> 24:55making the digital neurotherapy
24:55 --> 24:57available for the world,
24:57 --> 24:59you just create an account and you
24:59 --> 25:02play the games whenever you want.
25:02 --> 25:03Now you're right,
25:03 --> 25:05it does take effort in time.
25:05 --> 25:07The amount of time we're
25:07 --> 25:08talking about would be about.
25:12 --> 25:14100 minutes or so a week,
25:14 --> 25:17less than two hours a week and it can
25:17 --> 25:21be done anytime and it's painless.
25:21 --> 25:25It's actually enjoyable and you can
25:25 --> 25:29feel your systems getting stronger the.
25:33 --> 25:36So, yeah, so, so you can access it,
25:36 --> 25:38you you do it when you want,
25:38 --> 25:40but you do like you said, it does take time.
25:40 --> 25:42Now I I said it takes.
25:42 --> 25:45So like let's say you did a 20 minute
25:45 --> 25:47training session five days a week,
25:47 --> 25:5030 minute training session four times a week.
25:50 --> 25:52Think of it like going to the gym though.
25:52 --> 25:53You're absolutely right in these
25:53 --> 25:55it won't work unless you do it.
25:55 --> 25:56And it does take time.
25:56 --> 25:57Now it takes time in terms of what
25:57 --> 25:59we've talked about, the intensity,
25:59 --> 26:00how frequently per week,
26:00 --> 26:02but how long do you have to do it?
26:02 --> 26:04Well, in the published studies,
26:04 --> 26:07it was 4 weeks and there was dramatic
26:07 --> 26:09benefit that was done with actually
26:09 --> 26:11people were doing it five days a
26:11 --> 26:15week and doing it for an hour a day.
26:15 --> 26:18But we think of that if you do it
26:18 --> 26:20four times a week for 30 minutes,
26:20 --> 26:24five times a week for 20 minutes at home,
26:24 --> 26:27within 8 to 12 weeks,
26:27 --> 26:29people start feeling better.
26:29 --> 26:31And thinking better and then
26:31 --> 26:33building in more able to engage in
26:33 --> 26:35other activities in their lives,
26:35 --> 26:36which will amplify it.
26:36 --> 26:38As you said, amplify the benefits.
26:38 --> 26:39Attend their doctor's appointments,
26:39 --> 26:41remember their medication,
26:41 --> 26:42do exercise,
26:42 --> 26:45do more time reading spent and
26:45 --> 26:48interacting with other people.
26:48 --> 26:50Smiling more itself makes you feel better,
26:50 --> 26:53so it will build on itself.
26:53 --> 26:54Now the amount of time you have
26:54 --> 26:57it is that you know the sooner
26:57 --> 26:58you start the better.
26:58 --> 27:00Because we do know that the
27:00 --> 27:02presence of depression compromises
27:02 --> 27:04survival duration in patients with
27:04 --> 27:06cancer that's been established.
27:06 --> 27:09So I think that this would be
27:09 --> 27:11something that would be valuable for
27:11 --> 27:13people to start sooner rather than
27:13 --> 27:15later and work it into the routine.
27:15 --> 27:17And let me add further,
27:17 --> 27:19you try it and you feel, you know,
27:19 --> 27:21I'm just not feeling that well or I
27:21 --> 27:23had some chemotherapy that's really
27:23 --> 27:25making me just too exhausted to try it.
27:25 --> 27:26You can do it lying in bed,
27:26 --> 27:27by the way.
27:27 --> 27:30On your tablet, touchscreen tablet.
27:30 --> 27:32But I'm just too exhausted to even try it.
27:32 --> 27:35I'm just going to do 10 minutes today,
27:35 --> 27:36and this week I may only get in,
27:36 --> 27:38you know, 40 minutes total.
27:38 --> 27:39That's all right.
27:39 --> 27:41But then you can build it up gradually.
27:43 --> 27:45And so then the next question is
27:45 --> 27:47how long do the effects last?
27:47 --> 27:49So for example,
27:49 --> 27:52if you did this for four weeks,
27:52 --> 27:56as the studies as suggested is there.
27:56 --> 27:59A tail, in other words,
27:59 --> 28:01does this have a glow effect where
28:01 --> 28:03you know you've strengthened the
28:03 --> 28:05cognitive portions of your brain
28:05 --> 28:07and you can continue to reap
28:07 --> 28:09that benefit for years to come?
28:09 --> 28:10Or is this something that you
28:10 --> 28:12need to do on an ongoing basis?
28:12 --> 28:14Well, I think it's advantageous to
28:14 --> 28:16do it on a longer than four weeks
28:16 --> 28:19and longer than I'd said you can see
28:19 --> 28:21benefit for in the studies, 4 weeks,
28:21 --> 28:248 or 10 weeks we're recommending.
28:24 --> 28:27At a somewhat lower intensity use at home,
28:27 --> 28:29but I think there's more
28:29 --> 28:30benefit the longer you do it.
28:31 --> 28:33Doctor Bruce Wexler is a professor
28:33 --> 28:35emeritus and senior research scientist in
28:35 --> 28:38psychiatry at the Yale School of Medicine.
28:38 --> 28:40If you have questions, the address
28:40 --> 28:43is Cancer Answers at Yale dot Edu.
28:43 --> 28:45And past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Using Digital Neurotherapy to Address Depression and Anxiety in Patients with Cancer with guest Dr. Bruce Wexler July 23, 2023 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095