When Leanne Williams, PhD, started her career as a young psychotherapist just out of university, she was convinced that by understanding the psychology of human behavior she could treat severely mentally ill patients.
After a stint working in a mental facility in her native Australia, she changed her mind. Nothing she tried worked to alleviate her patients’ pain and suffering. One committed suicide, another spent his days tortured by internal voices that couldn't be silenced.
Looking for new answers, she returned to graduate school and decades later is now a neuroscientist and professor of psychiatry and behavioral sciences at Stanford. A story I wrote on Williams and her journey to make a difference in the lives of the mentally ill as a brain researcher, titled “Brain Waves,” appears in the most recent issue of Stanford Medicine magazine. It’s a feature on how insights from neuroscience could be used to customize care for people with anxiety, depression and other psychiatric conditions. And it tells the story of Williams' mission to make this a reality.
In the story, Williams describes how she, and others like her, believe that recent advances in neuroscience can be used to examine the brain, much like a cardiologist examines the heart. She refers to this as the "circuit approach" of mental-health treatment:
The circuit approach, Williams says, provides a scientific path toward more accurate disease diagnosis and treatment while helping eliminate the stigma associated with mental illness as a personal failing or weakness. "You boil it down to the superhighways of the brain, which are the routes where most of the neuronal traffic is going for the primary functions of the brain. Imagine the road system. There are all these little hiking trails, then you’ve got the big superhighways where most of the traffic occurs. These brain circuits are explaining those main routes."
Williams is experimenting with these methods in a clinical trial, know as the RAD Project, and hoping to provide scientific support to get them introduced into clinical care as quickly as possible. For three decades, her research has been working toward this end:
The RAD study envisions a future in which a physician with an anxious or depressed patient would order various neurobiological tests, such as an fMRI brain scan, to help make a more precise diagnosis and to guide treatment choice. Currently, the diagnostic categories are extremely broad, Williams says. Patients with anxiety or depression could have widely varying symptoms, and the cause could be very different, yet the first-line treatment is often the same. The model she is developing breaks down these broad diagnostic categories into "types" based on brain circuit dysfunctions. Matching each type of depression or anxiety with the best evidence-based treatment is the ultimate goal.
Previously: Precision health: a special report from Stanford Medicine magazine
Photo of Leanne Williams by Leslie Williamson