Arielle Sheftall, Ph.D. is determined to help young people navigate depression and anxiety by offering new treatments tailored to modern adolescents. She is using digital approaches that include a peer-to-peer support app and at-home nerve stimulation as methods of early intervention with high-risk teenagers. Her current research project will compare the efficacy of these two treatments, and is funded by the National Institutes of Health (NIH).
Over the past two decades, suicide rates have increased by roughly 35 percent, and the COVID-19 pandemic has further added to that. The predominant approach of treatment is secondary prevention: identifying the risk of reoccurrence for those who have already attempted suicide. But what if something could be done earlier?
Meeting them where they are
Many treatment options available to high-risk youth can be expensive, and are seen as quite intensive by some children and teens in the programs. Previous research has shown that many young people do not like face-to-face therapy, and gravitate toward digital delivery on their personal devices. Another obstacle is the availability of treatment to traditionally underserved communities. With all these things in mind, Sheftall, an associate professor of Psychiatry, wants to meet young people where they are: using cell phones to deliver new, experimental treatments. The project is taking an innovative and unconventional approach in the hope of finding better options for at-risk youth.
“We need to start early,” said Sheftall. “Once you get to adolescence, it’s a lot harder to peel back those layers of stress, depression, anxiety, suicidal behaviors, things that can build up over time. Then other things start happening in their environment which can make it potentially harder to treat a person.”
Sheftall is collaborating with two co-principal investigators from the University of Notre Dame: Theodore Beauchaine, Ph.D., and Kristin Valentino, Ph.D. Together, they will enroll 212 adolescents between the ages of 13 and 17 years, with half at URMC, and half at Notre Dame. Their project has proposed two new methods of non-traditional treatment that the NIH funding will help them develop, administer, and then analyze. One method is transcutaneous vagus nerve stimulation (tVNS), and the other method is a peer-support smartphone app.
During the project, investigators will assess participants’ individual risk profile and their needs, and participants will receive 30 days of one of three possibilities: solely tVNS, solely the peer support app, or a combination of the two.
Developing the treatment methods
Vagus nerve stimulation has been explored with adults and found to be effective in treating depression and anxiety over time. Sheftall has proposed questions about how to adapt this treatment for adolescents, while the human brain is still developing. Can tVNS be used with teenagers to shape the trajectory of their brain development?
Stimulation will be delivered via earbuds connected to a handheld device. The participant will learn how to use it in a clinical setting, then take the technology home and use it on their own. The use of earbuds also means they look commonplace, allowing participants a sense of comfort in using them publicly.
The other method of treatment is a peer support app. It will connect participants of the study to each other to address social isolation. It will be monitored for safety reasons. It includes features such as direct text messaging with a peer, interactive games and puzzles for the participants to work on together, and an option to self-report how they are feeling that day.
All participants will receive wearables, which can help track things like their sleep habits as well. For those using tVNS and the peer support app together, it can track their stimulation usage compared to how they are feeling, or compare usage to sleep habits.
On a personal note
This area of research and this project have a deeper meaning for Sheftall. She has been focused on suicide research since 2007, trying to understand the quality of care that patients receive while in an inpatient unit, as well as the care they receive after leaving. But that wasn’t the beginning. When she was only 14 years old, she lost her mother to cancer.
This loss took her down a dark path. She struggled with depression and anxiety, and even had suicidal thoughts. Despite spiraling into depression, Sheftall had a great family, who helped get her the treatment she needed.
“I’m so thankful that someone was there for me,” Sheftall said, “and was able to get me past that really dark space. Now, I want to help other people get past that space, overcome obstacles, and strive for greatness.”
Fast facts about the grant
The title of the five-year project is “Leveraging Noninvasive Transcutaneous Vagus Nerve Stimulation and Smartphone Technology to Reduce Suicidal Behaviors and Suicide Among Highly Vulnerable Adolescents” and is funded at $4 million over five years.
The grant is one of four awards from the NIH High-Risk, High-Reward Research Program, which supports “highly innovative research with the potential for broad impact.” The program is supported by the Common Fund at the NIH. Sheftall’s project earned the NIH Director’s Transformative Research Award. This award is given to teams who propose a project that is inherently risky and untested, but has great “potential to create or overturn fundamental paradigms.”