Challenges and Opportunities in Neuroimaging

DOI: 10.103711040-3590.19.1.58 Innovative Clinical Assessment Technologies: Challenges and Opportunities in Neufoimaging Gregory A. Miller Thomas Elbert University of Illinois at Urbana-Champaign University of Konstanz Bradley P. Sutton and Wendy HelIer University of Illinois at Urbana-Champaign The authors review the reasons for the contrast between the remarkable advances that hemodynamic and electromagnetic imaging of the human brain appear capable of delivering in clinical practice in psychology and their very limited penetration into practice to date. Both the heritages of the relevant technologies and the historical orientation of clinical psychology away from biological phenomena are factors. Discussion of some technical aspects and prospects of these methods and recommendations for facilitating clinical use are provided, with an emphasis on fostering the participation of and contribution by practicing clinical psychologists and professionals in related fields lacking a strong grounding in biological measurement. Keywords: electroencephalography, functional magnetic resonance imaging, magnetoencephalography, neuroimaging, optical imaging Adaptive or not, a change in the brain's software can-because psychological phenomena are driving the brain (sometimes medi of neuroplastic alterations of the neural substrate-prompt changes ated by psychological factors tuning gene expression, sometimes in the brain's hardware (Montague, Hyman, & Cohen, 2004) in more directly) and vice versa, it is not feasible to cast any of these ways that may contribute fundamentally to psychopathology (Hy players as "underlying" the others (Miller, 1996). Rather, all of man, 2005). Neuroimaging methods can assess many such func these measurement domains should be considered in clinical prac tional and structural changes that occur in mental illness as a tice, as has been advocated for decades (e.g., Davis & Lang, 2003; prelude to treatment or as a means of tracking its impact. If Kendler, 2005b; Kozak & Miller, 1982; Lang, 1968). Given that biological measures loom quite large in current research (and in funding of research) on psychopathology, the near absence of biological measures in psychological work with psychopathology Gregory A. Miller, Department of Psychology, Department of Psychi atry, and Beckman Institute Brain Imaging Center, University of Illinois at is striking. Biological measures have penetrated some other areas Urbana-Champaign; Thomas Elbert, Department of Psychology, Univer of routine clinical practice that have substantial participation by sity of Konstanz, Germany; Bradley P. Sulton, Department of Bioengi clinical psychologists, such as behavioral medicine. The article neering and Beckman Institute Brain Imaging Center, University of Illinois considers what has held back biological measurement more at Urbana-Champaign; Wendy Heller, Department of Psychology and broadly in clinical psychology practice and its prospects for Beckman Institute Brain Imaging Center, University of Illinois at Urbana progress. Champaign. Definitionally, mental illness in an individual is traditionally This article was undertaken while Gregory A. Miller was a guest conceptualized in terms of subjective experience as manifested in, professor at the University of Konstanz, Germany. The study was sup and diagnosed on the basis of, self-report and overt behavior ported by Grant R2! DA!4!11 from the National Institute of Drug Abuse; Grant RO! MH61358, Grant T32 MH!4257, and Grant T32 MH!9554 (Kendler, 2005b). Indeed, mental illness is fundamentally a psy from the National Institute of Mental Health; and funding from the Uni chological phenomenon, not a biological phenomenon (Miller, versity of Konstanz, the German Research Foundation, and the University 1996). Nevertheless, mental illness can be viewed as a psycholog of Illinois Beckman Institute and Intercampus Research Initiative in Bio ical manifestation of maladaptive brain organization or function technology. Stimulating conversations with Patrick Berg, Brigilte Rock that arises from an unfavorable interaction of genome and envi stroh, and many other colleagues at the University of Konstanz contributed ronment, including the ongoing modulation of gene expression by to the ideas in this article. Thanks are also due to Jeffrey D. Lewine, past and current environments. The rapidly growing scientific and Don M. Tucker, and Andrew G. Webb for consultation on some of the popular literature on the human genome unfortunately has pro issues discussed in this article, Jennifer L. Stewart and Sarah M. Sass for moted the indefensible assumption that genes will eventually pro comments on a draft, and Anna S. Engels for help in preparing Figures I vide an essentially sufficient explanation of psychological dys and 2. Correspondence concerning this article should be addressed to Gregory function. Compelling arguments against the appealing simplicity A. Miller, Department of Psychology, University of Illinois at Urbana of the notion that there could be "a gene for [diagnosis)" are Champaign, 603 E. Daniel Street, Champaign, IL 61820-6232. E-mail: readily available (e.g., Kendler, 2005a), if not widely noted. As is [email protected] increasingly acknowledged in the literature on behavioral genetics 58 59 in psychopathology, the action is very likely to be in Gene x cation of the concept of event-related fMRI by Dale and Buckner Environment interactions, not in gene main effects (e.g., Moffitt, (1997) surprised many in the electroencephalography (EEG) com 2005; Moffitt, Caspi, & Rutter, 2006), whereas more direct genetic munity because the key elements of the method and its critical effects are likely to be at explanatory levels far removed from importance in experimental design had become the consensus 25 manifest psychopathology (Gottesman & Gould, 2003; Kendler, years earlier in the EEG literature (e.g., Hillyard, Squires, Bauer, 2005a). Furthermore, the relevant Gene x Environment interac & Lindsay, 1971). It was extremely valuable that the authors (one tions are likely to prove difficult to ferret out because much of the with an EEG/magnetoencephalography [MEG] background) environmental contribution will be what behavioral geneticists brought this to the attention of the fMRI community, but it is also have called nonshared, specific to the individual (not shared with, striking that it needed to be said. say, an identical twin; McGue, 1999; Turkheimer, 2000). Whether This unfortunately intermittent cross-fertilization between more or how often or in what ways we will find that the biology is and less mature methods is reflected in the human fMRI literature driving the psychopathology or the psychopathology is driving the more broadly during its short history. Until very recently, the biology remains to be established (Kendler, 2005b; Miller, 1996). necessary hardware was housed almost exclusively in radiology Widiger and Clark (2000) cited several diagnoses for which bio departments, where much of the clinical emphasis and technolog logical findings have been proposed as compelling evidence for a ical firepower historically have been focused on anatomy rather diagnosis, but they noted that there is no consensus that inclusion than function, with virtually no involvement of psychologists. As of such criteria is justified or useful. What can be emphasized, a result, expertise in experimental design critical for studies of without naive reductionism, is that an important feature of biology cognitive and emotional function and dysfunction was initially associated with psychopathology is likely to be abnormal cerebral thin, with predictable consequences for the long-term substantive network architecture with altered neural connectivity (Harrison & significance of much of the early work. This must be framed, Weinberger, 2005; Meehl, 1962), with symptoms observed in however, not as a failure of the fMRI field but as a normal language expression, physiology, and overt behavior (Lang, 1978; characteristic in the development of any young field. Clinical and Miller & Kozak, 1993). Conventional diagnosis, such as Interna cognitive psychologists as well as basic neuroscientists, steeped in tional Classification of Diseases and Diagnostic and Statistical methods for addressing function and dysfunction, are increasingly Manual of Mental Disorders classifications based on rating scales involved in fMRI research. The relatively small literatures on brain that focus on verbal report and overt behavior, is fundamentally source localization via EEG and MEG in clinical practice are also limited by largely overlooking biological data. growing rapidly, with extensive participation by and impact on It is commonplace to comment on recent progress in brain clinical, cognitive, and biological psychology. This cross imaging technologies with great enthusiasm, particularly in claims disciplinary participation bodes very well for, and is indeed a that we can now do things we could not do recently. Such claims prerequisite to, bringing advanced biological methods into the are almost always false, in that most of the progress is much more clinic. Rather than wonder why the physicists and radiologists are incremental. It has been possible, for example, to image brain taking so long, it is time for clinical psychologists to go after the function noninvasively for decades, even in the strict sense of technology. image meaning a three-dimensional representation. What has changed in recent years is that impressive

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