Identifying mental health disorders before they emerge

Reading reactions to stressors: How it works

Brain-based biomarkers are measurable indicators of brain function or activity that provide information about brain processes that contribute to psychiatric symptoms.

These biomarkers can be measured using the following technologies:

• Electroencephalography (EEG), which uses small sensors attached to the head to measure and record electrical activity in the brain. It helps doctors see how the brain is working by showing patterns of brain activity.
• Startle eyeblink potentiation, which is a way to measure how strongly someone’s blink reflex increases when they are reacting to stress. The blink response shows researchers how sensitive a person’s brain is to stress and how threats and anxiety are processed in the body.
• Functional magnetic resonance imaging (fMRI), which is a brain scan that shows which areas of the brain are active by measuring small changes in blood flow. By examining patterns of brain activity during specific tasks or emotions, researchers can identify changes that may be linked to mental health conditions.

All three technologies can be used during the NPU test, allowing researchers to measure how the brain and body respond to stress in real time.

Measuring mental health in real time

Shock sensors are placed on your wrist – or sometimes on your foot. Before the test starts, you choose the level of intensity for the shock. The NPU test is safe, but it is also mildly irritating or unsettling.

“Patients sit there in this state of anxiety and stress. It’s safe to say most people don’t enjoy this test, but individuals react differently,” Dr. Gorka says.

Throughout the test, a number countdown flashes on the screen.

At times, this countdown signals when the shock is about to happen; other times, the numbers are meaningless and the shock is unpredictable.

Patients are left to anticipate it.

The test is insightful, in part, because it gets to the crux of what’s at the center of many mental health conditions – coping with uncertainty.

“Uncertainty is uncomfortable for everyone. Our brains are constantly trying to predict and prepare for what might happen next, so when a stressor is uncertain, it can trigger a strong sense of anxiety. Your sensitivity to uncertainty develops pretty early in life and you carry that with you,” she says. “How people tolerate uncertain stress plays a big role in how people cope with day-to-day life.”

Some people are more adept than others at coping with uncertainty and stress. Others intensely struggle, and that’s when disorders and issues can surface.

“If you want to develop better treatments, and you want to fix something, you first have to be able to measure it,” Dr. Gorka says.

Traditionally, mental healthcare has focused on separate, categorical diagnoses like panic disorder, post-traumatic stress disorder or substance use disorders.

“Dr. Gorka is one of the first people in the field to consider stress, anxiety and addiction as deeply interconnected,” says Dr. Phan, who holds the Jeffrey Schottenstein Endowed Chair in Psychiatry and Resilience. “These issues are not identical, but their close interaction means they must be considered together.”

The conditions often overlap and patients frequently experience multiple disorders simultaneously, Dr. Gorka explains.

“What if we could peel back the layers of those diagnoses and truly understand what lies at the core of someone’s functioning?” she says. “If we could design treatments that target those underlying issues – instead of just addressing superficial diagnoses – we might create interventions that are more effective, widely applicable and that truly get to the heart of the problem in a much more direct and meaningful way.”

Looking ahead: The future of stress science

Dr. Gorka’s work could transform how mental health conditions are detected, monitored and treated.

One way to do that is use the tests to help identify risks early in life.

By giving the NPU test to large groups of preteens, scientists could identify young people who show heightened risk.

“With that knowledge, we could give these adolescents education about their risk levels. We could even help them learn prevention strategies early, potentially changing the trajectory of their mental health before serious problems ever start,” she says.

“I think substance use, in particular, is a devastating illness. It affects the person, but it also affects all the people around them. The public health significance is high,” Dr. Gorka says.

She has drawn from her own life and experiences as she tries to reshape the field of psychiatry.

“Both of my siblings have struggled with substance use, and I haven’t, even though we grew up in the same environment. That highlights something we see all the time – family environment matters, but factors like personality and biology also play a big role in who becomes vulnerable and who remains resilient.”

Making the threat anticipation available

Dr. Gorka is already working to integrate these tools into routine care.

At Ohio State, the NPU test is already being incorporated into care at Talbot Hall, where inpatient drug and alcohol addiction services are offered, and at the Depression Recovery Center in the Department of Psychiatry & Behavioral Health.

“We’re starting to track these stress markers throughout treatment in our existing clinics,” Dr. Gorka says. “These markers could help guide decisions about care: If stress responses remain elevated, a patient may benefit from continuing or intensifying treatment. If those markers begin to normalize, clinicians might transition patients to maintenance strategies or less intensive support.”

Tackling a full continuum of mental health influences

Dr. Gorka has launched an outpatient clinic at Ohio State called Continuum.

“It’s designed to rethink how we treat mental health,” she says. “Continuum is built on whole-person mental healthcare.”

Rather than focus on symptoms of mental health conditions, a cross-disciplinary team that includes psychologists, psychiatrists and nutrition specialists focuses on combining treatment with physical health, lifestyle medicine and personalized data to better understand the root causes of distress.

“I am just trying to do better – just trying to have better treatments for the patients themselves but also for the families,” Dr. Gorka says. “I really feel passionate about that part of it.”