Study Combines Wearable Tech, Brain Imaging to Innovate Treatments for Paranoia

A smartphone vibrates in someone’s pocket. The notification asks a simple question: “How are you feeling right now?” But the message isn’t from a clingy friend or pushy relative.

Instead, it’s part of a UMD study using mobile and wearable technology to help improve treatments for extreme paranoia while increasing our understanding of the disorder’s neurobiological building blocks and the environments in which it flourishes.

In casual language, “paranoia” often refers to mild feelings of social anxiety—for example, about why you were left off an email at work or whether your siblings are maneuvering to make you host Thanksgiving this year. In its clinical definition, paranoia is the mistaken belief that intentional harm is likely to occur; it spans a range of intensities, from low-level ideation to profound delusions—that is, from mildly uncomfortable uncertainty about others’ intentions to an unshakable conviction that one is being persecuted by government agents.

Led by Associate Provost and Professor Jack J. Blanchard, Associate Professor Alex Shackman and Assistant Research Scientist Jason Smith—all in the Department of Psychology—the project was awarded a $3.7 million grant over five years from the National Institutes for Mental Health in 2021. In 2018, seed grant funding from the Brain and Behavior Institute (BBI) allowed the team to gather preliminary data and lay the groundwork for the proposal submission and subsequent award.

The project provides a crucial first opportunity to compare brain circuit functions as quantified in the artificial confines of an MRI scanner to those that occur during everyday experiences and behaviors, measured by smartphones and wearables, Shackman said.

“Traditional fMRI brain scans make use of procedures that are well-controlled but highly artificial,” said Shackman. “They require a subject to lie absolutely still in a small dark tube while being bombarded by loud noises. How natural is that?”

The UMD team first devised an innovative collection of fMRI tasks that are more lifelike, dynamic and immersive than the norm in similar studies. These tasks are centered around a battery of high-definition videos, including a suspense-filled Alfred Hitchcock thriller, bodycam footage recorded on crowded sidewalks in London and Manhattan, amateur cellphone and security camera footage of chilling scenes (accidents, explosions, bodily assaults, casually walking along the ledge of a skyscraper), and close-up footage of racially diverse actors displaying a range of emotional expressions, from welcoming smiles and crinkled eyes to threatening gestures and aggressive shouts.

Meanwhile, to improve measurements of paranoia as it ebbs and flows in real-world contexts, the investigators turned to technologies like sleep monitors and location tracking. Frequent smartphone-based surveys through an “ecological momentary assessment” (EMA) help overcome limitations of the subject’s memory about events that could trigger paranoia throughout the day.

Passive mobile datastreams unobtrusively track participants’ physical location and activity, which can be cross-referenced against location data used to define the amount of threat in various environments. The team can then quantify associations between where a subject is, how they feel and how they react to momentary particular events, from traveling on a public bus to making a purchase in an unfamiliar store. This novel combination of data from EMA, specific community information and geolocation could identify the everyday factors that promote upticks in momentary paranoia, the researchers said.

For Blanchard and Shackman, one of the most exciting elements of the project is the introduction of a wrist-worn sleep actigraphy device to objectively monitor sleep-wake data.

“Devising new treatments generally takes a lot of time and money, but there is already plenty of good infrastructure for treating sleep, such as therapists and sleep centers,” said Shackman. “If poor sleep quality turns out to be a key trigger, we could repurpose these resources to help people suffering from debilitating levels of paranoia.”

For a grand challenge like understanding the root causes of paranoia and other mental illnesses, actionable hypotheses and targets are vital.

“Psychiatric disorders, including extreme paranoia, impact many millions of people across the world,” noted Shackman. “The U.S. has an opportunity become a real leader in developing new insights into the mechanisms that give rise to those illnesses.”