Dr Yoko Nagai
Digital therapeutics: Non-pharmacological approach for neurological and psychiatric disorder
Epilepsy
Recent advances in digital and sensor technology, and the popularisation of wearable devices for measuring physiological changes in the body, has led to a surge of interest in how autonomic functions can be harnessed to promote health and well-being. However, the application of biobehavioural interventions, notably biofeedback training, to treat psychological or physical symptoms is constrained by a limited understanding of the underpinning mechanisms, and a paucity of empirical data regarding interactions between the brain and dissociable sub-systems of the autonomic nervous system (ANS). My sustained programme of work, with a focus on epilepsy, illustrates how the systematic investigation of autonomic nervous control, which details the integration of central and peripheral physiological processes during volitional ANS regulation, can inform the targeted application of biofeedback as a clinical treatment.
The overall aim of the proposed PhD research is to challenge the traditional view of pharmaceutical only approach to management of epileptic seizures. The student will investigate the mechanisms and the process of occurrence and suppression of epileptic seizures which has long been considered to happen randomly and uncontrollable. We will investigate this from the perspective of the functional autonomic governance of peripheral (interoceptive) state - an enriched perspective relative to the narrow central targets of antiepileptic drugs. Our primary research question is how the autonomic nervous system interacts dynamically with the central nervous system in epilepsy to cause and inhibit the occurrence of seizures.
Hikikomori (Sever social withdrawal of young adults)
A specific severe form of social withdrawal had been observed in Japan over the past few decades. In 1998, the term Hikikomori was coined by a Japanese psychiatrist; Tamaki Saito, initially described as staying at home for six months or more and avoiding participating in social activities, unexplained by other mental disorders. Until recently, Hikikomori was viewed as a culture bound syndrome that may be related to the Japanese culture of overprotection of children and acceptance of overdependent behaviour. Social withdrawal can be so severe that family members prepare meals for the individual and leave them outside their door, as portrayed in Japanese films and media. This level of isolation might be difficult to understand in different cultural contexts. There is now a consensus that the general Hikikomori phenomenon is not confined to Japan; it also exists across the globe. This raises the questions about the relevance of traditional Japanese culture as a causal link to Hikikomori.
This PhD project aims to investigate the therapeutic potential of virtual reality as a tool to alleviate severe social anxiety, with the goal of improving the condition and well-being of affected individuals.
Key references
- Nagai Y, Aram J, Koepp M, Lemieux L, Mula M, Critchley H, Sisodiya S, Cercignani M. Epileptic seizures are reduced by autonomic biofeedback therapy through enahancement of fronto-limbic connectivity: A controlled trial and neuroimaging study. EBioMedicine 2018, 27: 112-122.
- Nagai Y, Goldstein LH, Fenwick PBC, Trimble MR. Clinical efficacy of biofeedback treatment on reducing seizures in adult epilepsy: a preliminary randomized controlled study. Epilepsy & Behaviour 2004, Vol 5/2: 216-223.
- Nagai Y, Jones CI, Sen A, Galvanic Skin Response (GSR)/Electrodermal/Skin Conductance Biofeedback on Epilepsy: A systematic review ad nmeta-analysis. Frontiers Neurology, 2019
- Nagai Y, Kartar A, Pfaff M and Elkholy H. The paradox of Hikikomori through transcultural lens. BJPsych International. 2024 In press
Visit Yoko's for a full list of publications.
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