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Post-traumatic stress disorder (PTSD) is a psychiatric illness that develops after an individual is exposed to traumatic life events. PTSD leads to changes in brain anatomy and neurophysiology. Suicide is a major health problem, and the global suicide mortality rate amounts to 1.4% of all deaths worldwide. Most suicides are related to psychiatric disease, with depression, substance use disorders and psychosis being the most relevant risk factors. However, anxiety, personality-, eating-, and trauma-related disorders, as well as organic mental disorders, also contribute.
Traumatic stress has caused a host of devastating effects for many military service members, including mental illness, substance abuse, post-traumatic stress disorder, family violence, and suicide. Since Sept. 11, 2001, more than 30,000 active duty members and veterans have taken their own lives — a tragic toll that represents four times the number of those killed in post-911 military operations.1 Developing effective approaches to prevent suicide is a top priority within the Department of Defense.
DARPA’s STRENGTHEN program, short for Strengthening Resilient Emotions and Nimble Cognition Through Engineering Neuroplasticity, aims to build on recent advances in neuroscience and clinical practice to increase well-being and prevent or mitigate the effects of traumatic stress leading to behavioral health disorders and suicidality.
The program endeavors to accomplish this through enhancing cognitive flexibility (CF) and emotional regulation (ER), key behavioral health mechanisms that act as protective buffers against traumatic stress. CF refers to the mental ability to switch between thinking about two different concepts according to the context of a situation. ER is a conscious or nonconscious strategy to start, stop, or otherwise modulate the trajectory of an emotion. STRENGTHEN will attempt to identify, modulate, and ultimately optimize the brain circuits responsible for CF and ER.
“Current methods to prevent and treat these outcomes vary from talk therapy to electroconvulsive therapy, but they share a disease model and consequent goal of relieving symptoms rather than targeting the brain network causes.”
“Trauma and stress change brain networks’ function resulting in the cognitive rigidity and emotional dysregulation associated with mental illness, substance abuse, and suicidality,” said Dr. Greg Witkop, a former Army surgeon, who manages the STRENGTHEN program in DARPA’s Defense Sciences Office. “Current mental health intervention approaches rely on diagnostic categories based on descriptive symptoms rather than a mechanistic understanding of brain network dysfunction causing those symptoms. By identifying and optimizing the brain networks associated with cognitive flexibility and emotional regulation, STRENGTHEN seeks to heal — and prevent — changes in the brain networks caused by traumatic stress.”
STRENGTHEN will strive to enhance the mental protective mechanisms of CF and ER through two goals: (1) Development of individualized brain network models of CF and ER and (2) design of hybrid interventions to induce neuroplastic change in the functional connectivity and/or structure of CF and ER brain networks to optimize an individual’s CF and ER.
The STRENGTHEN program is collaborating with the Department of Defense’s Center for the Study of Traumatic Stress (CSTS) at the Uniformed Services University in Bethesda, Maryland. The DARPA-CSTS partnership will harness the substantial literature and scientific expertise in the field of ER and CF to promote the nascent effort to link them in neurocognitive models. The joint effort uses the National Institute of Mental Health’s Research Domain Criteria research framework and will attempt to develop the first suite of interventions to both prevent and treat the psychological impact of traumatic stress — often referred to as Invisible Wounds of War — and promote psychological health.
Earlier in 2022, DARPA launched the Neural Evidence Aggregation Tool (NEAT) program with the aim of identifying people at risk of suicide by measuring and analyzing their preconscious brain signals. “By bringing together recent advances in cognitive science, neuroscience, physiological sensors, data science and machine learning,” DARPA said that “the NEAT program will develop processes that can measure what a person believes to be true.”
While mental health among soldiers is a serious issue for the Department of Defense, applications coming out of the NEAT program have the very real potential to give governments and corporations the ability to hack human beings at the preconscious level.
Strengthening Ties for Enhanced Resilience:
On November 15, 2022, DARPA’s STRENGTHEN program received a significant boost through a collaboration with the Department of Defense’s Center for the Study of Traumatic Stress (CSTS). This partnership brings together cutting-edge research on neuroplasticity with CSTS’ vast clinical experience in PTSD and trauma. Here’s what this alliance potentially offers:
- Deeper understanding of trauma: CSTS expertise can help refine STRENGTHEN’s interventions by shedding light on the intricacies of trauma response and individual differences in resilience.
- Enhanced intervention design: Collaborating with clinicians can ensure the program’s approaches are not only theoretically sound but also practical and adaptable for real-world application.
- Improved ethical considerations: CSTS’ ethical framework for trauma research can guide STRONTHEN’s development to ensure sensitive handling of participant data and well-being.
AI Learning Tools: A Pathway to Individualized Therapy?
On September 7, 2023, DARPA’s AI Tools for Adult Learning program awarded $750,000 in grants, opening doors for potential contributions to STRENGTHEN’s goals. While not directly linked, these projects explore AI’s potential in personalized learning, which could benefit STRENGTHEN in the following ways:
- Developing adaptive interventions: AI could personalize therapy based on individual needs and progress, tailoring interventions to maximize effectiveness.
- Real-time feedback and monitoring: AI-powered tools could track progress and emotional fluctuations, providing data for clinicians to fine-tune interventions and offer timely support.
- Scalability and accessibility: AI-based technology could potentially reach wider audiences by offering self-guided or remote therapy options, supplementing traditional clinical approaches.
USU Center and DARPA Join Forces to ‘STRENGTHEN’ Mental Health in Military and Veterans
In a significant effort to combat suicide and improve mental health among service members and veterans, the Uniformed Services University’s Center for the Study of Traumatic Stress (CSTS) has partnered with the Defense Advanced Research Projects Agency (DARPA) on a novel program called STRENGTHEN.
This multifaceted program, involving researchers from leading universities and hospitals, aims to develop groundbreaking treatments that target and optimize brain circuits associated with resilience and well-being. At its core, STRENGTHEN focuses on two key aspects:
- Cognitive flexibility: Enhancing the ability to adapt thinking to new situations and challenges, allowing individuals to switch more easily between suicidal thoughts and reasons to live.
- Emotional regulation: Improving the ability to manage emotions like grief and loss without being overwhelmed, leading to better emotional health.
By leveraging advancements in neuroscience, biomedical engineering, and clinical practice, STRENGTHEN will explore innovative ways to optimize brain circuits related to these crucial skills. This, in turn, aims to enhance overall well-being and prevent or mitigate the effects of traumatic stress, including diverse mental health disorders and suicidality.
The program features a multi-phase approach. Initially, teams will develop hybrid interventions using techniques like transcranial magnetic stimulation therapy alongside cognitive behavioral therapy, targeting various risk levels of suicidality in three separate cohorts. Success in this phase paves the way for refining and expanding the interventions to reach wider populations.
USU’s CSTS plays a vital role in STRENGTHEN, offering expertise and guidance to DARPA and research teams. They will ensure program findings translate into research, policies, and initiatives dedicated to supporting service members and veterans. Additionally, the CSTS will serve as an Independent Verification and Validation (IV&V) partner, ensuring the program’s accuracy, validity, and feasibility.
Beyond verification, the IV&V team, led by CSTS experts, will foster collaboration among researchers, evaluate progress against milestones, and critically analyze interventions for potential scalability and application within military and veteran healthcare systems.
This collaborative effort marks a significant step forward in safeguarding the mental health of military personnel and veterans. By focusing on fundamental mechanisms of resilience and well-being, STRENGTHEN holds the potential to revolutionize mental health care for these critically important populations.
Looking Ahead: A Promising Horizon for Mental Health:
These developments signify a growing focus within DARPA on bolstering mental health research and innovation. While STRENGTHEN is still in its early stages, the collaboration with CSTS and the potential of AI in personalized learning paint a promising picture for the future:
- More effective interventions: By combining neuroscience, clinical expertise, and AI, STRENGTHEN has the potential to develop truly game-changing interventions for those struggling with trauma and its sequelae.
- Holistic approach to mental health: The program’s focus on resilience building and neuroplasticity could move beyond symptom management towards promoting overall well-being and preventive measures.
- A model for future research: As STRENGTHEN progresses, its insights and methodologies could serve as a model for future research on mental health, paving the way for more personalized and effective interventions.
