Global collaboration brings new hope for therapies that reduce delusions.

Dr. Rafal Skiba

For people managing schizophrenia and their loved ones, hope can sometimes seem a world away. The BC Schizophrenia Society Foundation, in partnership with Michael Smith Health Research BC, is helping to bring together researchers from across the globe to collaborate on groundbreaking new therapies for a common symptom of schizophrenia – jumping to conclusion bias.

In January 2022, Michael Smith Health Research BC/BC Schizophrenia Society Foundation Research Trainee Award recipient, Dr. Rafal Skiba, will move from his home base in Poland to join Dr. Todd Woodward at the University of British Columbia’s Cognitive Neuroscience of Schizophrenia Laboratory (CNoS) to collaborate on a three-phased study. The CNoS lab is focused not only on understanding the symptoms of the disease, but also translating this knowledge in a way that helps those affected.

Understanding Jumping to Conclusion Bias

At first glance, jumping to conclusion (JTC) bias might seem insignificant. We can all think of a time we caught the end of conversation at a party or heard a rumour about some changes at work. If we don’t have all the information, we can misinterpret or think the worst. For most, these kinds of reactions are infrequent or tempered as we gather more details and process the information. For those with schizophrenia, the tendency to overgeneralize or make a quick decision without all the evidence can lead to frequent errors in beliefs and reasoning.

“There are plenty of studies showing that people who jump to conclusions more often have higher probability of delusions occurring,” says Dr. Skiba, who is currently working on the first phase of the study from Poland. This might include believing that something bad will happen or that someone wishes them harm. “So our goal is to decrease the number of these delusional hypotheses.” In this phase, he is analyzing data collected by the CNoS lab on 60 patients with schizophrenia. “The study measured functional brain activity and thus the severity of the jumping to conclusion bias present when the patients were performing a particular task,” he explains. This is helping them to identify the specific pathways and frequencies in the brain that activate when they are forming a hypothesis based on certain evidence given to them. Once this analysis is complete, Dr. Skiba will join Dr. Woodward in Vancouver, BC to collaborate in person on Phases 2 and 3.

Pursuit of answers leads researcher to Vancouver, BC

Relocating is not new to Dr. Skiba. His studies and career have taken him from New York City and Reno, Nevada to Berlin, and the Swiss Center for Affective Science at the University of Geneva. He has a passion for understanding mental disorders, including post-traumatic stress disorder (PTSD), autism, and personality disorders, with a specific focus on brain science and neural mechanisms. “That’s why I want to work with Dr. Woodward,” says Dr. Skiba, “because he developed this metacognitive strategy training (MCT) for schizophrenia.” MCT is a non-pharmaceutical approach to reprogramming the brain. “You teach a person about the science of the disorder and how to deal with the faults that we all have but which are increased when people are experiencing delusions.” The data Dr. Skiba is looking at in Phase 1 involve patients undergoing MCT and whether the therapy changes how the brain responds. Skiba’s specialization in brain mechanisms will help shine a light on what exactly is happening in the brain during Dr. Woodward’s MCT therapies. It’s a collaboration that brings hope for new therapies for schizophrenia patients.

Skiba’s interest in cognitive problems and access to effective treatment was piqued early as he observed close friends struggling with anxiety. His studies shifted from psychology to brain science, when more than one person close to him presented with a mental disorder. He is currently working on a program of MCT with a close family member with schizophrenia. “I’m proud that I can help him,” he says as he describes how his knowledge of clinical mental disorders and the brain complements Dr. Woodward’s therapeutic program.

A study in three phases

The overall goal of the three-phased study is to see if neural modulation (mild electrical pulses) will enhance MCT’s impact on the jumping to conclusion bias. But before this is attempted on schizophrenia patients, the team will test the approach on a control group first. Phase 2 of the study will recruit 40 UBC students over six months to undergo transcranial alternating current stimulation (tACS). While this sounds a little daunting to the layperson, it is a safe procedure that involves placing a cap on the student’s head and administering a very mild electric current to stimulate specific areas of the brain.

Finally, in Phase 3, the team will recruit 150 patients with schizophrenia and study them over two years. One third of the subjects will undergo MCT with neuromodulation, one third MCT without neuromodulation, and one third will receive treatment as usual. Having identified the neural pathways related to decision-making, the intent is that safe electrical modulation will strengthen these connections and reduce the number of delusions patients experience. “A six-week program of MCT could be highly effective in teaching people how to doubt,” says Skiba. By stimulating certain areas of the prefrontal cortex, “they will have better focus and better concentration to understand and consider disconfirming evidence.”

Working with patients to build trust

A key part of successful treatment is trust that it will work. So far, the MCT training is going well for Dr. Skiba’s family member. “On average, people feel better after MCT treatment. I actually see progress, and that was a really powerful experience for me,” says Dr. Skiba. “He’s finally understanding that the voices that he hears are because of the illness and not his fault, so he stops blaming himself. For me, that’s extremely rewarding to see.” That sense of reward is what Dr. Skiba hopes to amplify as he crosses the globe once again to help more schizophrenia patients to better understand their disease.

BCSSF funding in partnership with Michael Smith Health Research BC secures Dr. Skiba’s salary for three years and Phase 2 of the research. The team is in the process of securing funding for Phase 3.