Mood Disorders Centre
Published on: 25 June 2014
The Mood Disorders Centre aims to better understand why certain treatments work. Image courtesy of Shutterstock.
Anxious and stressed students are being helped by research from Exeter’s Mood Disorders Centre (MDC), where academics are also improving treatments for a range of mental health conditions.
Research focuses on improving psychological understanding of mood disorders such as depression, bipolar disorder, and anxiety through basic experimental work, translating their findings into better treatments, then evaluating and making them as widely available as possible.
The MDC works closely with Exeter's Clinical Education Development and Research (CEDAR) group, providing clinical psychologist and cognitive behaviour therapist trainees with access to cutting edge research and a workforce to support the NHS’ mood disorders treatment.
Much of the Centre’s work is carried out in the £3.6million Sir Henry Wellcome Building for Mood Disorders Research. Funded by a Wellcome Trust capital grant and launched in 2012, the building provides a purpose built space for mood disorders research and treatment.
Understanding to treatments
Ed Watkins, Professor of Experimental and Applied Clinical Psychology, has conducted research to understand what causes people to get stuck in unhelpful worry and rumination, which is the tendency to repeatedly dwell on difficult events and moods.
He explained: “In the lab we’ve done experiments showing the way you think repetitively about difficult and upsetting events influences whether such thinking is helpful or unhelpful – we found thinking about the specific details of how events happened is more helpful than thinking about why it happened and what it means.”
These findings have been used to adapt and improve cognitive-behavioural therapies (CBTs) for depression. CBT reduces depression by challenging negative thoughts and encouraging patients to change their behaviour by increasing positive activities.
A face to face version of the treatment has been found to be a useful addition to medication for hard-to-treat depression. More recently, an internet-based treatment called MindReSolve has been developed as an intervention to prevent depression in the at-risk.
Professor Watkins said: “We targeted young adults who are high worriers and ruminators, who we know are at elevated risk for becoming depressed. We conducted a study with Dutch colleagues and recruited more than 250 high worriers between the ages of 16 and 20, who were randomised to receiving our internet-treatment, a group-version of the treatment or no treatment.
“We found there was a 13 per cent chance of developing major depression in people who had the intervention, compared to 32 per cent for those who didn’t.”
This MindReSolve intervention is now used by the University’s Wellbeing Services to help anxious and stressed students.
The next phase of this research is to understand how CBT for depression works.
Professor Watkins explained: “A problem with CBT is we know the treatments work, but we don’t know how they work – we don’t know what the active ingredients are.”
A factorial study – which looks at individual components of treatments, as opposed to the whole package – is underway to understand which elements help.
The MDC are working with Cornwall NHS Foundation Partnership Trust to run this study through their Improving Access to Psychological Therapies service. It provides the Trust with a new treatment option and helps Centre staff to evaluate and develop better treatments in a real service environment, making treatment more widely available.
There are a number of other basic lab science research programmes, all with the potential to lead to improved treatments.
One of Professor Watkins’ former students, Associate Research Fellow Dr Henrietta Roberts, is working with Dr Barney Dunn on an online study investigating the role of the reward system - a collection of brain structures that attempts to regulate and control behaviour by inducing pleasurable effects - in vulnerability to mood disorders and unhealthy lifestyle behaviours such as overeating. The study aims to discover whether some people are more susceptible to such behaviours, because they are less able to enjoy normal pleasurable activities.
Participants are being recruited through the Exeter 10,000 Study, which aims to recruit 10,000 volunteers living near Exeter to help improve healthcare. The Study is overseen by the National Institute for Health Research (NIHR) Exeter Clinical Research Facility (CRF), a collaborative effort between the University and Royal Devon and Exeter NHS Foundation Trust.
Dr Roberts is also investigating whether rumination might deplete working memory capabilities. She is testing whether training people to improve working memory could reduce susceptibility to repetitive negative thinking, in collaboration with Dr Anna Adlam, of the Centre for Clinical Neuropsychology Research (CCNR) (CCNR).
Dr Roberts explained: “Dr Adlam had ideas linking her expertise in working memory to vulnerability factors for depression and Professor Watkins mentioned I was interested in cognitive control and rumination. We got talking and successfully applied to the University’s Wellcome Trust ISSF [Institutional Strategic Support Fund]. The project will compliment my PhD research, and examine unanswered questions about working memory in negative repetitive thinking.”
The training programme could be a useful resource in reducing repetitive negative thinking, and can be downloaded to the user’s computer.
Dr Kim Wright studies mania – periods of extreme elevated or irritated mood in bipolar disorder - and investigates whether the biases in processing positive information may contribute to mania such as increased biases to positive rewards.
Improving treatments and access
A number of treatment trials are underway or have been recently completed in the Centre.
Professor Willem Kuyken led the PREVENT trial, funded by the NIHR Health Technology Assessment, which investigated whether mindfulness-based CBT – which involves patients learning mindfulness meditation in groups to learn how stop unhelpful behaviours and spot depression warning signs - and is a better alternative for preventing relapse into depression for people with a history of recurrent depression than using antidepressants. Recruitment was successful and the analyses will be finalised soon.
Dr Heather O’Mahen recently completed trials of an internet-delivered form of CBT for women with perinatal and postnatal depression (depression occurring during pregnancy) in collaboration with Netmums. The research has suggested this approach is effective for these important and often under-served groups.
The €9million Multi-country cOllaborative project on the rOle of Diet, Food related behaviour, and Obesity in the prevention of Depression (MooDFOOD) project, of which Exeter is a key site, will investigate how dietary and lifestyle modifications can prevent depression in at-risk overweight people. One thousand patients across England, Spain, the Netherlands and Austria will be followed up for one year.
The Centre is also working with the military charity Help for Heroes to help set up a psychological disorders evaluation and treatment service for military veterans and their families. Professor Watkins said: “There are similar programmes in the NHS, but none have been set up for specifically for military veterans and their families. There is a big gap in provision of treatment here, and this is an excellent example of how the MDC seeks to increase the accessibility of evidence-based treatments.”