Using technology to diagnose PTSD and its subtypes

An HRI Research Trainee is using neuroimaging and machine learning to discover how post-traumatic stress disorder (PTSD) is related to patterns of brain activity, and the findings could have important implications for both diagnostic and preventative medicine.

Dr. Andrew NicholsonDr. Andrew Nicholson is a post-doctoral fellow affiliated with Western University, McMaster University and Lawson Health Research Institute. His postdoctoral fellowship is funded jointly by Mitacs Elevate and HRI, and his research focuses on the use of neuroimaging techniques to advance healthcare.

In a recent publication co-authored by HRI Associate Clinical Scientist, Dr. Ruth Lanius, and Homewood Research Chair in Mental Health and Trauma, Dr. Margaret McKinnon, Dr. Nicholson reported findings that suggest technological advances may enable early diagnosis of PTSD and its clinical subtypes.

About the study

Machine learning multivariate pattern analysis predicts classification of posttraumatic stress disorder and its dissociative subtype: a multimodal neuroimaging approach was published last month in Psychological Medicine.

In his study, Nicholson and his team used functional MRIs to document patterns of resting brain activity in three groups:

  1. Individuals with no history of PTSD (healthy control group)
  2. Individuals diagnosed with PTSD, and
  3. Individuals diagnosed with the dissociative subtype of PTSD (PTSD + DS)

The dissociative subtype of PTSD is characterized by symptoms of detachment and emotional numbness. It is different from the more familiar type of PTSD, which often results in difficulty controlling strong emotions and outbursts.

Nicholson’s study found that when patterns of brain activation were fed into a machine learning algorithm, the computer system predicted the classification of PTSD, PTSD + DS ,and healthy controls in new subjects with 91.63% accuracy.

Functional MRI images from Dr. Nicholson’s study show patterns of brain activity that are used to detect and classify a PTSD diagnosis.

How can these findings advance healthcare?

Dr. Nicholson’s findings suggest that distinct patterns of brain activity are associated with specific forms of PTSD. These brain activity patterns are considered unique biomarkers that may aid in the early diagnosis and intervention of PTSD and its subtypes. Nicholson’s findings may also help people with PTSD understand that there is a physical basis for their disorder.

New technologies can help us understand how symptoms of mental illness are related to brain activity. They enable the potential for detecting diagnoses that may not have been previously suspected or considered, and they facilitate expedient and objective diagnoses, opening the door to more individualized treatment approaches.

Dr. Nicholson’s work is unearthing valuable neurobiological clues about how to classify and better treat mental illness. To follow his research, visit

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Holiday Giving Banner Image

The holiday season is the perfect time to become a champion and help people struggling with mental illness and addiction.

From now until December 31, we invite you to support HRI’s Holiday Giving Campaign and make a donation that will help us change lives through research. Your donation will help to:

  • Transform mental health and addiction services through research
  • Improve care through the measurement of treatment outcomes in mental health and addiction
  • Engage leading scientists, universities, patients and clinicians
  • Merge research with practice to improve care faster

Meet our Campaign Chair: Janice Lace

Janice worked at Homewood Health Centre for 30 years. As Director of Operations, she collaborated with HRI on a number of research initiatives to improve patient care. We are grateful to Janice for her support and are honoured that she has agreed to serve as our 2018 Campaign Chair.

“I believe the partnership between HRI and Homewood Health has the potential to transform mental health in Canada.” – Janice Lace

HRI Research Day: find out how your donations are used

We welcome you — our community, partners, friends and followers — to learn about studies currently underway on HRI Research Day 2018.

Speak directly with our scientists and research trainees to find out how HRI is helping to fill critical gaps in Canada’s mental health and addiction systems.

Riverslea BuildingHRI Research Day 2018
Tuesday, November 27
11 a.m. to 1 p.m.
HRI Offices, Riverslea Building
150 Delhi Street, Guelph ON


New this year: the Darlene Walton Scholarship Fund

We are pleased to announce a new scholarship to support students entering the field of mental health and addiction research.

Darlene WaltonThe Darlene Walton Scholarship Fund honours the legacy of a dear friend to HRI. For 38 years, Darlene worked at Homewood Health Centre, giving her best each day to help patients recover. An avid supporter of HRI, she recognized the importance of training the next generation of researchers to improve care in Canada.

Sadly, Darlene passed away in June of 2018. You can support Darlene’s vision of a brighter future by directing your donation to the Darlene Walton Scholarship Fund when you make a donation online today.

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Upcoming Symposium on Addiction and PTSD

Addiction and post-traumatic stress disorder (PTSD) often occur together, causing debilitating consequences for those affected. There is little consensus among clinicians about how best to treat individuals suffering from both disorders, but new research is providing hope for patients and healthcare providers alike. This will be the focus of an upcoming symposium.

ConferenceIn October, experts from HRI and Homewood Health Centre will discuss the latest science, outcomes and promising practices related to the treatment of co-occurring addiction and PTSD at the 2018 Canadian Society for Addiction Medicine Annual Meeting and Scientific Conference (CSAM).

Each year, CSAM brings together researchers, educators and clinicians from across Canada and around the world. This year, the conference explores the theme “Crisis, Controversy and Change”, shedding light on the urgent need for improvements to mental health and addiction care. Experts from various disciplines will present research and exchange ideas to advance science and treatment.

The joint symposium, coordinated by HRI Research and Evaluation Scientist, Dr. Jean Costello, will feature the following speakers and topics:

  • Dr. Vivian Sarabia, Addiction Physician at Homewood Health Centre, will discuss the leading hypotheses that attempt to explain why PTSD and addiction often occur simultaneously;
  • Sabrina Kaur Syan, a PhD student working alongside HRI Senior Scientist Dr. James MacKillop, will present results from a study that investigates PTSD symptom severity as a predictor of drop-out from inpatient addiction treatment;
  • Dr. Hollam Sutandar, Addiction Psychiatrist at Homewood Health Centre, will discuss a pilot study that examines the use of Cognitive Processing Therapy in treating patients with co-occurring PTSD and addiction; and
  • Dr. Margaret McKinnon, Homewood Research Chair in Mental Health and Trauma, will share findings from a trial investigating the use of Goal Management Training (a cognitive skills training program) in patients with PTSD, as well as patients with co-occurring PTSD and addiction.

This symposium is an excellent example of the collaboration between Homewood Health Centre clinicians and HRI researchers. Together, we are generating findings and bringing new treatment ideas into practice sooner.

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Promoting Patient-Oriented Research

Recovery from addiction can mean different things to different people. A recent publication by HRI Research and Evaluation Scientist, Dr. Jean Costello, highlights the importance of incorporating insights from people with lived experience when building systems for measuring treatment success.

How to Measure Addiction Recovery? Incorporating Perspectives of Individuals with Lived Experience was published in the June 2018 edition of the International Journal of Mental Health and Addiction. Co-authored by Senior Research Associates, Courtney Ropp and Sarah Sousa, and HRI Senior Scientist, Dr. Brian Rush, the article outlines a study conducted between December 2014 and March 2015. Study participants were recruited from the Addiction Medicine Service Aftercare/Relapse-Prevention Program at Homewood Health Centre.

Group discussionThrough a series of focus groups and interviews, researchers identified four major themes related to how participants perceived recovery:

  1. Recovery is a process.
  2. Abstinence is an important aspect of recovery, but not sufficient.
  3. Recovery is multidimensional.
  4. Recovery requires ongoing commitment.

The authors conclude that recognizing recovery as a life-long process reinforces the need to measure and monitor outcomes well after treatment is completed. Further, input from individuals with lived experience helped to identify a number of important indicators of recovery that should be measured as part of a comprehensive outcome-monitoring system.

This study promotes the concept of human-centred design, which incorporates insights from end users during the development of a product or service. In this instance, patients are helping to shape research that will be meaningful to others experiencing addiction.

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Leading Evaluation Expert Joins HRI Team

We are pleased to announce that Dr. Brian Rush, Scientist Emeritus with the Centre for Addiction and Mental Health, has joined the HRI team as Senior Scientist.

Dr. Brian RushDr. Rush is a leading international expert in program and policy evaluation. With a research career that spans nearly 40 years, he has a particular interest in performance-measurement systems for substance abuse, problem gambling and mental health services. Dr. Rush will play an integral role in further developing the Recovery Journey Project at HRI.

The Recovery Journey Project is a rigorous data-collection system that allows for the ongoing evaluation of mental health and addiction treatment at Homewood Health Centre in Guelph, Ontario. The system holds great potential for guiding improvements to care in Canada and beyond.

Led by Dr. Jean Costello, Research and Evaluation Scientist, the Recovery Journey Project is a flagship model that can be adapted for use in a range of treatment settings to measure recovery outcomes. Dr. Rush will work alongside Dr. Costello as the Recovery Journey Project expands.

Recovery Journey Project Highlights:

  • One of Canada’s only longitudinal studies measuring mental health and addiction recovery success
  • Helps us monitor and evaluate treatment quality and effectiveness
  • Generates knew knowledge about the recovery process
  • Can help determine how best to use limited resources to help as many people as possible
  • Adaptable to fit other treatment domains and settings

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Multi-year research study sheds light on addiction recovery

Since 2015, Homewood Research Institute (HRI) has partnered with Homewood Health Centre to collect data from patients who receive treatment in the Centre’s Addiction Medicine Service (AMS).

Originally known as Post-Discharge Outcomes Monitoring or PDO, this data-collection system is led by HRI researchers and was piloted to allow for the rigorous and ongoing evaluation of the quality and effectiveness of Homewood’s program by collecting and analyzing data from patients as they navigate their first year of recovery after treatment.

HRI is pleased to announce that, as of April 30, 2018, the PDO system has a new name and has been embedded into regular practice within the Addiction Medicine Service. Clinical data is collected by AMS staff while patients are receiving inpatient treatment. Following discharge, patients are then invited by HRI to take part in research on the recovery process.

Recovery Journey Project feature imageNow known as the Recovery Journey Project, this collaborative effort is one of the only longitudinal studies in Canada designed to measure key indicators of recovery over time. The Recovery Journey Project will help us better understand the recovery process among those who receive mental health and addiction treatment. In this way, it will guide improvements to programs and lead the way to measurement-based services – at Homewood and beyond.

To mark the launch of the Recovery Journey Project as a fully integrated research study at Homewood, HRI has created a microsite outlining the project’s key features and findings. Updates and knowledge translation activities will be shared as the study progresses.

What’s Next?

The potential impact of the Recovery Journey Project is vast: this framework can be utilized to measure recovery outcomes across a range of treatment domains. Currently, the system is being refined for implementation within other Homewood Health programs.

For updates on the Recovery Journey Project, subscribe to HRI Connects or visit

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Dr. Margaret McKinnon honoured as inaugural chairholder

Dr. McKinnon welcomed to new role

Dr. Paul O’Byrne welcomes Dr. McKinnon (Photo credit: JD Howell)

On Monday, April 16, guests from McMaster University, Homewood Research Institute (HRI), Homewood Health and St. Joseph’s Healthcare Hamilton gathered to honour Dr. Margaret McKinnon as she stepped into her new role as Homewood Research Chair in Mental Health and Trauma.

The role marks the strategic partnering of McMaster, HRI, Homewood Health and St. Joseph’s in a joint effort to advance treatment for trauma-related mental illness and addiction.

Leaders from partnering organizations were present to congratulate Dr. McKinnon and discuss the impact of building a national network – known as the Homewood-McMaster Trauma Research Network – to advance treatment for trauma.

President and Vice-Chancellor of McMaster University, Dr, Patrick Deane, spoke about the importance of collaboration in academic settings to advance healthcare research. Dr. Kevin Smith, CEO of St. Joseph’s Health System, and Dr. Paul O’Byrne, Dean and Vice-President of the Faculty of Health Sciences at McMaster, shared details about the novel partnership, which aims to merge existing clinical expertise in applied clinical research with new treatment ideas, research, evaluation and knowledge exchange to improve treatment and outcomes for people experiencing PTSD.

Dr. Ron Schlegel, Chair of the HRI Board, discussed the value of funding research initiatives that invite collaboration – particularly among leading researchers and institutions in the field – to advance common goals in mental health and addiction treatment.

Dr. McKinnon is developing a Trauma Research Program at HRI and will play a key role in building the Homewood-McMaster Trauma Research Network, which will have its foundations in Ontario and expand across Canada in a multi-year process.

Margaret McKinnon speaking

Dr. Margaret McKinnon speaks about her research and the importance of investing in solutions for people struggling with trauma (Photo credit: JD Howell)

Group photo

L-R: Dr. Patrick Deane, Dr. Paul O’Byrne, Dr. Margaret McKinnon, Dr. Kevin Smith and Dr. Ron Schlegel (Photo credit: JD Howell)

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Moral injury: Exploring the consequences of a wounded conscience

A Vietnam veteran was once asked about his struggle to make eye contact with others since returning from war.

“I can’t look anyone in the eye for fear that they will see the stain on my soul for what I’ve done in Vietnam,” he replied.

This powerful statement summarizes the experience of many veterans and military members. And, in large part, it summarizes what it means to suffer a moral injury.

A moral injury occurs when a person has to witness, fails to prevent, or engages in an event that violates their personal moral beliefs. For example, military members may encounter situations or be forced to make choices that conflict with their own ethical standards.

Exposure to morally injurious situations has been linked to adverse outcomes, including post-traumatic stress disorder (PTSD). The concept of moral injury in relation to PTSD has emerged in the past decade and has been identified as a vital area of study for mental health researchers – particularly those working with military members and veterans.

Currently we have a very limited understanding of how the brain and body respond to moral injury, but one HRI Scientist is looking for answers.

Finding answers through innovative research

“We can only understand how to treat moral injury if we understand the mechanisms underlying it,” says Ruth Lanius, MD, PhD and HRI Associate Clinical Scientist.

Dr. Lanius is Professor of Psychiatry, Director of the PTSD Research Unit and the Harris-Woodman Chair in Mind-Body Medicine at the Schulich School of Medicine and Dentistry at Western University. Her research interests focus on the neurobiology of PTSD and the development of new treatments.

In collaboration with colleagues Chantelle Lloyd, Charlene O’Connor and Dr. Margaret McKinnon, Dr. Lanius is leading groundbreaking research that uses neuroimaging to explore how the brain processes morally injurious events.

“PTSD is often thought to be the primary mental health concern for individuals returning from war,” says Dr. Lanius.

“But moral injury is an emerging and highly important consideration. Moral injury brings profound shame, anguish and guilt that can severely disrupt quality of life and daily function. We need to better understand how moral injury develops and how our bodies process moral injury in order to help people recover successfully.”

Still in its early stages, Dr. Lanius’s research aims to do just that: gain insight into the wounded conscience and learn how to treat those wounds.

To learn more as Dr. Lanius’s research develops, subscribe to HRI Connects or follow HRI on Twitter, Facebook and LinkedIn.

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