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Neurofeedback, also called ‘brain training,’ consists of exercises where individuals regulate their own brain activity. In a new study from Lawson Health Research Institute and Western University, researchers have found that neurofeedback may be an effective treatment for individuals with post-traumatic stress disorder (PTSD). Published in NeuroImage: Clinical, the clinical trial found that neurofeedback was effective in reducing symptoms of PTSD.   

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“Brain connectivity involves different parts of the brain communicating with each other and helps to regulate states of consciousness, thought, mood and emotion,” explains Dr. Ruth Lanius, scientist at Lawson, professor at Western’s Schulich School of Medicine & Dentistry and psychiatrist at London Health Sciences Centre. “Individuals with PTSD tend to have disrupted patterns of brain connectivity, but our research suggests they can exercise their brains to restore patterns to a healthy balance.” 

Neurofeedback uses a system called a neurofeedback loop in which a person’s brain activity is measured through sensors placed on the scalp and displayed back to them using a computer interface. This allows the individual to complete exercises and visually see the results. 

The trial tested neurofeedback with a total of 72 participants, including 36 participants with PTSD and 36 healthy control participants. Of those with PTSD, 18 were randomized to participate in neurofeedback treatment while the other 18 acted as a comparison group.  

The study found that the severity of PTSD symptoms decreased in participants randomized to receive neurofeedback treatment. After treatment, 61.1 per cent of participants no longer met the definition for PTSD. This remission rate is comparable to gold standard therapies like trauma-focused psychotherapy. 

The research team also used functional magnetic resonance imaging (fMRI) at St. Joseph’s Health Care London to capture brain scans of participants both before and after participation in the trial. They found that individuals with PTSD experienced positive changes in brain connectivity in the salience network and the default mode network following neurofeedback treatment.  

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“The salience network is involved in detecting threat as part of the ‘fight or flight’ response. It is normally hyperactive in individuals with PTSD. Meanwhile, the default mode network is activated during rest and is involved in autobiographical memory. We often see that this network is less active during rest and functionally disrupted among individuals with PTSD,” says Dr. Andrew Nicholson, affiliated scientist at Lawson. “Neurofeedback helped restore the functional connectivity of both networks to healthier levels.” Dr. Nicholson is an assistant professor at McMaster University and was formerly a post-doctoral fellow at Schulich Medicine & Dentistry.  

The study involved weekly sessions of neurofeedback over 20 weeks. Participants were asked to reduce the intensity of the brain’s dominant brain wave – the alpha rhythm. Brain activity was visualized as either a still cartoon or a distorted picture. If the alpha rhythm was successfully reduced, the cartoon started moving or the picture started becoming clearer.  

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“Participants were not instructed on how to reduce the alpha rhythm. Rather, each individual figured out their own way to do so,” notes Dr. Lanius. “For example, individuals reported letting their mind wander, thinking about positive things or concentrating their attention.” 

The team notes the treatment could have a number of clinical implications following further validation. 

“Neurofeedback could offer an accessible and effective treatment option for individuals with PTSD,” says Dr. Lanius. “The treatment is easily scalable for implementation in rural areas and even at home.” 

Read more about neurofeedback and the team's research:

• Leveraging technology to diagnose psychiatric disorders
• Solving the mysteries of PTSD

In June 2016, a public health emergency was declared in London, Ontario when HIV rates amongst injection drug users more than doubled.

What was abnormal about the emergency in London? The outbreak occurred despite London having Canada’s largest per capita sterile needle and syringe distribution program, a strong opiate substitution therapy program and a multidisciplinary HIV clinic. Many locations with outbreaks in HIV among persons who inject drugs implement these interventions to lower rates of transmission, but they already existed in London.

Researchers at Lawson Health Research Institute and Western University recognized there must have been a novel method of HIV transmission and looked to find a solution.

In two new studies published in the Journal of Acquired Immune Deficiency Syndrome (JAIDS), the research team found for the first time that HIV can be transmitted through sharing of equipment used to prepare drugs before injection and that a simple intervention - heating the equipment with a cigarette lighter for 10 seconds – can destroy the HIV virus, preventing the transmission.

From August 2016 to June 2017, the research team interviewed 119 injection drug users to understand their injection behaviours and risk for HIV. They discovered that those who shared equipment used to prepare drugs for injection were 22 times more likely to contract HIV than those who did not, despite not sharing needles or syringes.

The equipment includes a metal ‘cooker’ used to dissolve drugs in water and a filter used to draw the mixture, known as ‘the wash,’ into the syringe. Injection drug users reported reusing the equipment when consuming controlled-release hydromorphone, one of the most commonly injected opioids.

“Controlled-release hydromorphone is expensive and difficult to dissolve. After the first wash, large amounts of the drug remain in the equipment which is then saved, shared or sold for future use,” explains Dr. Sharon Koivu, Associate Scientist at Lawson and Associate Professor at Schulich Medicine & Dentistry. “While people know not to share needles, some use their own needle multiple times allowing for contamination of the equipment.”

The team took their findings back to the research laboratory. They confirmed that, on average, 45 per cent of the drug remains in the equipment after the first wash. They not only confirmed the HIV virus can be transmitted between needles, cookers and filters, but also discovered that controlled-release hydromorphone has properties that promote survival of the virus.

“The slow release properties in the drug can unfortunately stabilize the HIV virus,” says Eric Arts, PhD, Chair of the Department of Microbiology and Immunology at Schulich Medicine & Dentistry. “For the first time, we were able to demonstrate that sharing equipment could lead to the type of HIV outbreak we observed in the community.”

The team discovered that when the cooker is heated with a cigarette lighter for approximately 10 seconds, or until the wash bubbles, the virus is destroyed. They termed the technique ‘cook your wash.’

The team also confirmed that heating the cooker did not impact drug concentration.

“We had to make sure that cooking your wash would not change the amount of drug being drawn into the syringe,” notes Dr. Michael Silverman, Lawson Associate Scientist and Chair/Chief of Infectious Diseases at the Schulich School of Medicine & Dentistry, Western University, London Health Sciences Centre and St. Joseph’s Health Care London. “If too much drug was released, it could lead to overdoses. If any drug was burnt off or lost, the intervention would not be accepted by persons who inject drugs.”

Partnering with local community organizations like the Middlesex-London Health Unit and Regional HIV/AIDS Connection, ‘Cook Your Wash’ was launched as a public health campaign. 

“The ‘Cook Your Wash’ campaign is one of the most exciting things to happen in our community,” says Dr. Koivu. “We learned from persons who inject drugs, took that information to the lab to develop a solution and then brought that solution back to the community in record time.”

Dr. Silverman adds that local rates of new HIV cases fell dramatically after the introduction of the campaign. “It wasn’t the sole reason for the reduction in HIV rates as other interventions were also introduced, but the timing suggests it was part of the solution.”

The team hopes this research can be used to inform understanding and interventions in other centres facing HIV epidemics amongst persons who inject drugs.

“We hope our findings can be used to reduce the incidence of HIV transmissions even further and that, one day, society will be HIV free,” says Dr. Silverman.

The two studies, “Heating Injection Drug Preparation Equipment Used for Opioid Injection May Reduce HIV Transmission Associated with Sharing Equipment” and “Sharing of Injection Drug Preparation Equipment is Associated with HIV Infection: A Cross Sectional Study,” are published in the Journal of Acquired Immune Deficiency Syndrome (JAIDS). 

A first-of-its-kind study led by Lawson Health Research Institute is receiving $1.2 million in funding from the federal government, delivered through the Veteran Homelessness Program, to better understand homelessness amongst women in Canada who are military Veterans.

“This is an important and yet often invisible problem,” says Dr. Cheryl Forchuk, Lawson Assistant Scientific Director based at St. Joseph’s Health Care London’s Parkwood Institute and the study lead. “This is the first Canadian study to focus exclusively on women Veterans’ experience of homelessness. Gender matters, especially when we’re talking about female Veterans who are homeless. If they’ve experienced sexual trauma or abuse or have children, and the only Veteran housing available is a group setting for men, that will be an issue.”

Dr. Forchuk and her team have begun travelling to cities and towns across Canada to conduct interviews with female Veterans experiencing homelessness or who have previously experienced homelessness. They will gather data such as demographics, history of housing and homelessness, and services accessed. The team will also host focus groups with homeless- and Veteran-serving agency staff. The locations have been selected in partnership with The Royal Canadian Legion and other Veteran-serving groups, focusing on areas with pockets of female Veterans experiencing homelessness. 

“We will also explore the pathways and experiences of homelessness, what barriers are faced, what has been helpful and what future services should focus on,” adds Dr. Forchuk.

“This study is a vital step towards addressing the unique challenges faced by female Veterans experiencing homelessness,” says Peter Fragiskatos, Parliamentary Secretary to the Minister of Housing, Infrastructure and Communities and Member of Parliament for London North Centre on behalf of the Honourable Sean Fraser, Minister of Housing, Infrastructure and Communities. “By investing in research like this, we are making significant progress in understanding and improving the support systems for this population, contributing to the federal government's efforts to end homelessness among Veterans.”

“This significant investment reflects our dedication to addressing the issue of homelessness among female Veterans,” says Arielle Kayabaga, Member of Parliament for London West. “By supporting this pioneering study, we aim to uncover the specific barriers they face and develop targeted solutions that honour their service and ensure they receive the support they deserve.”

The goal of the four-year study is to ensure there is accurate data to inform gender-specific interventions and guidelines for policy, practice and care of female Veterans. Canadian Armed Forces Veterans make up a disproportionate percentage of those experiencing homelessness according to a 2018 report.

“It is clear that the circumstances surrounding this particular subset of our Veteran population are not well enough understood,” says Carolyn Hughes, Director of Veterans Services with The Royal Canadian Legion. “It is our hope that this project will help fill in some of those blanks and at the same time, further enlighten all of us who serve Veterans, so that we may provide even more timely and focused assistance when and where it’s needed most.”

St. Joseph’s Parkwood Institute has an embedded legacy of Veterans’ care, having originally been a Veterans’ hospital and now hosting a Veterans’ inpatient centre, the Operational Stress Injury (OSI) Clinic, as well as the MacDonald Franklin OSI Research and Innovation Centre. The research centre is recognized as Canada’s leader in mental health research dedicated to enhancing the lives and wellbeing of military personnel, Veterans and their families. The directors of the centre are co-investigators on the study.

For more information, please contact:    
Debora (Flaherty) Van Brenk 
Communication Consultant
St. Joseph’s Health Care London
C: 226-577-1429 or 519-318-0657
T: 519-646-6100 ext. 42534
@email

Massive investment by the Workplace Safety and Insurance Board (WSIB) to St. Joseph’s Health Care London is largest-ever grant to transform occupational illness and injury

A “game-changer” investment of $65.75 million to Lawson Research Institute of St. Joseph’s Health Care London will transform the prevention, diagnosis and treatment of workplace injuries and illness for Ontarians.

The Workplace Safety and Insurance Board’s visionary 10-year commitment is the WSIB's largest-ever research injection; the largest non-government health research funding in London history; and the biggest single grant received and stewarded by St. Joseph’s Health Care Foundation.

The investment will launch the Occupational Injury Prevention and Treatment Research Network – a first-in-Canada hub where people, technology and science-backed innovation will help solve the human and health costs of occupational injury and illness across Ontario and around the world.

Landmark work, global leadership

“This is a game-changer, something that will transform how we work together to get ahead of work-related injury, pain and mental illness,” says Lisa Porter, PhD, Vice-President Research at St. Joseph’s and Scientific director of Lawson, the research arm of St. Joseph's.

“This investment will propel us to global leadership in finding solutions to some of the most pervasive issues affecting people in workplaces today,” Porter says.

Occupational injuries and illnesses – including chronic pain, physical disability and mental health conditions – accounted for more than 93,000 claims registered through the WSIB last year, with an average lost work time of 63.2 days.

Occupational injuries and illnesses – including chronic pain, physical disability and mental health conditions – have a significant impact on many people, families and businesses in Ontario. Every year they account for almost 250,000 claims registered through the WSIB, with benefit payments of approx. $2.5 billion.  

“Too many Ontario families experience the human cost of workplace injury,” says Jeffery Lang, President and CEO of the WSIB. “We want fewer injuries to happen, and if they do, to be able to help people with a safe and faster recovery. This research is going to help get us there and with their established expertise, the St. Joseph’s Health Care and Lawson Research Institute team are a natural partner for this important work.”  

 Investment and innovation

The network will innovate long-term solutions to prevent mental and physical injuries, accelerate recovery and ensure sustainable health for Ontario workers.

It will feature state-of-the-art infrastructure and expertise including:  

• A first-in-Canada positron emission tomography/magnetic resonance imagery (PET/MRI) scanner dedicated to research into rapid and accurate diagnosis of mental health conditions including post-traumatic stress and depression
• A cutting-edge Computer-Assisted Rehabilitation Environment (CAREN), a unique, virtual-reality environment that will test and solve workplace injury, rehabilitation and chronic pain in new ways
• Three new endowed research Chairs and teams of scientists solving the most critical research questions plaguing people injured at work, an investment that will ensure long-term consistency and sustainability of the work
• Deploying technology in data science, artificial intelligence (AI) and virtual reality, making the network accessible by centres and workplaces across Canada

Rapid-access research area to design and test assistive devices such as splints and mobility technology  

St. Joseph’s President and CEO Roy Butler says, “We know that discovery-driven, patient-focused research improves lives – that is the focus of our hospital-based research at Lawson, and we’re humbled that the WSIB has entrusted us to expand this vital work to minimize the effects of workplace injury, disease and disability. This significant investment will drive innovation opportunities that will translate into novel new treatments and tools that can be used to battle workplace injury and illness”

“This investment will enable us to leverage the deep expertise St. Joseph’s already has in mental health, chronic pain and rehabilitation, and creates the opportunity to expand our knowledge to support workplace wellness, including for frontline health-care workers,” Butler says.

Butler adds that the network will strengthen existing partnerships and create new collaborations – within St. Joseph’s as well as among a wide range of health professionals, researchers, post-secondary institutions and industry locally, across the province and nationally.  

Butler notes St. Joseph’s already excels in research and treatment for related injuries and illnesses.

That includes: preventing and treating chronic pain through the hospital’s Pain Management Program and the Gray Centre for Mobility and Activity hand and upper limb care and injury prevention through the Roth | McFarlane Hand and Upper Limb Centre; advanced imaging expertise; and mental health solutions for veterans and first responders at the MacDonald-Franklin OSI Research Centre. All are specialty research areas of St. Joseph’s with deep roots in addressing occupational injury and illness.

A partnership of promise

Many groundbreaking research initiatives at St. Joseph’s have been made possible by generous supporters of St. Joseph’s, says Michelle Campbell, President and CEO of St. Joseph’s Health Care Foundation.

Medical research in Canada, including the research done in our hospitals, relies heavily on private funding.  Donors to our foundation, invest in research because they know that innovation leads to better frontline care, and healthier communities,” Campbell says.  

“It’s a partnership of promise, a confident stride toward better outcomes for patients. The WSIB’s gift through St. Joseph’s Health Care Foundation is a whole new level of leadership, and we’re proud to be integral to this transformation in workplace health,” says Campbell.

Earlier this year, the WSIB announced a $20-million gift to Fanshawe College to create a Centre of Excellence in Immersive Technology for Workplace Safety, primarily to help first responders and responders-in-training learn to prevent and treat occupation-related mental health issues such as PTSD, anxiety and depression.

The Network at St. Joseph’s broadens that work to bring research-specific innovation aimed at benefiting the physical and mental wellbeing and safety of workers in all occupations.

The new hub at St. Joseph's will make use of the institution’s vast community and research partnerships throughout London and across Canada, in multiple collaborations across a wide range of health disciplines.