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As a clinical psychologist, Anthony King, PhD, has long witnessed the debilitating effects of trauma. He serves on the team at Ohio State University College of Medicine’s Center for Psychiatry and Resilience and as associate professor at the Ohio State College of Medicine’s Department of Psychiatry and Behavioral Health.
“Before the pandemic, studies found about 70% of the general population experienced some form of trauma in their lifetime,” Dr. King says. “However the rates of trauma exposure are much higher among some communities, and the pandemic has also led to increases in trauma exposure. The overall lifetime prevalence of post-traumatic stress disorder (PTSD) in the U.S. is 6%, but is twice as high in women (8%, about 1 in 12 women) than in men (4%, about 1 in 25 men), and again much higher in some communities. A person’s risk for developing PTSD depends on a number of factors, including the kind of trauma, the number of trauma exposures and other things like level of social support.”
Because of the prevalence of PTSD and other trauma-related disorders in our society, Dr. King is learning more about how trauma affects people and communities that experience mental health disparities due to low income, structural racism or other socio-economic factors, and those who also experience higher levels of lifetime trauma exposures.
In addition, Dr. King is researching how community-based interventions and treatments for trauma- and stress-related disorders — like PTSD and depression — could be implemented to help alleviate mental health disparities. In particular, he wants to understand which approaches may be the most effective in building resilience and growth.
Resilience is not simply a personality trait, it’s a dynamic process
Our brains and nervous systems have built-in processes to tell our bodies how to respond, adapt to and recover from stressors like trauma, Dr. King says. This can be thought of as a reservoir of resilience that guards our natural sense of safety, security, intimacy and trust. However, when we experience too much trauma over months or years, our innate resilience can be worn down or overwhelmed. We feel trauma more acutely and are less able to adapt and recover.
As such, resilience is a dynamic process that represents an interaction between the numbers and kinds of traumas we’re exposed to, as well as the availability of inner and external resources. These resources include relationships and social support, emotional regulation and coping styles, a sense of hope and optimism, access to healthy food and physical fitness and adequate time for rest and restoration. When we experience constant stress or adversity, especially when we have fewer resources, our brains can become more sensitive to threat and stress, increasing our vulnerability to mental health issues, such as PTSD, substance use, depression or anxiety.
Dr. King and his colleagues believe it’s possible for our brains and nervous systems to build back resilience with positive interventions that strengthen our inner resilience resources. These interventions help us better understand and express our emotions, change our habitual patterns of behaviors in response to stressors and other triggers, and better tolerate objectively safe situations that feel uncomfortable.
The mindfulness approach to building resilience
Dr. King has been working with mind-body and mindfulness-based interventions as a potential treatment approach for PTSD, as well as with methods to build resilience for people who have experienced traumatic or highly stressful conditions. He’s particularly interested in how training in interoceptive and metacognitive exercises could help trauma patients by changing the activity and connectivity of certain brain networks.
While traditional forms of trauma exposure therapy are considered first-line treatment and can be highly effective, difficulties with engagement and early patient drop-out are linked to sub-optimal outcomes. Dr. King hypothesizes that mindfulness training itself can be a form of therapeutic exposure to one’s aversive thoughts and feelings, and when combined with traditional exposure therapy might enhance emotional regulation skills and improve outcomes.
In 2016, Dr. King published a randomized controlled pilot study that tested the effects of mindfulness-based exposure therapy” (MBET, which combines mindfulness-based cognitive therapy [MBCT] with in vivo exposure) in a group of combat veterans with PTSD. The study found that MBET led to changes in how the brain processes social-emotional threats, as well as increased connectivity in brain networks involved with rumination and with cognitive control that was correlated with symptom improvement. Dr. King hypothesized this change in network connectivity is linked to increased metacognitive/reflective functioning. He has since followed up that research and independently replicated the network connectivity effect with a new study of MBCT on civilian women in the community with PTSD that’s currently in preparation for publication.
The Nancy Jeffrey Endowed Professorship and Research Fund
Dr. King plans to study the relationships between mental health disparities, trauma and resilience as the inaugural Anne K. “Nancy” Jeffrey Endowed Professor in Mental Health Equity and Resilience at the Ohio State College of Medicine.
“The COVID pandemic really highlighted existing mental health inequities,” Dr. King says. “I became very interested in how these inequities affected marginalized and under-resourced communities, and what kinds of approaches would be most helpful and accessible for managing stress and building resilience. We started some initial studies of mindfulness-based approaches with residents of low-income areas in Detroit and surrounding areas, to see if these approaches would be acceptable and helpful to address pandemic-related stress and mental health consequences in these communities.”
Dr. King moved this program of research to Ohio State, which the endowment from the Jeffrey family in honor of Anne K. “Nancy” Jeffrey now supports. The endowment allows Dr. King to perform neuroimaging and physiological studies of risk and resilience on the brain and conduct community outreach in resilience treatment development and research with the goal of increasing access for underserved communities to mental health interventions for stress, trauma, depression and anxiety.
In this first year, Dr. King has enrolled 35 people with PTSD from the Columbus community into clinical research trials for MBET group psychotherapy interventions and resilience training for people with trauma histories living in under-resourced areas. He plans similar studies in the future, also including community members with chronic pain and opioid abuse issues.
Community outreach to support resilience
The community outreach will include a collaboration with the African American Male Wellness Agency on its mental health wellness initiative and programming. Dr. King also plans to add community-based mental health screenings using wellness coaches to connect to mental health providers and offer resilience training and other problem-solving programs that will specifically address the community’s needs.
Dr. King sees the prevalence of trauma in our lives as both an opportunity and a challenge. “As we move past the pandemic, we see how everyone’s lives have changed, but also this huge gradient of change,” he says. “People with fewer resources are having a harder time of it. I want to know how we can be helpful now, and I’d also like to learn what we can do to help those who may develop depression, anxiety or substance abuse problems in the future due to mental health disparities. How might it be possible to help build resilience for those who most need it?”
