Many people suffering from addictions express a genuine desire to quit; nonetheless, they continue to choose the immediate short-term high of a drug over future greater rewards such as health, family and friends. Why does a person continue to do something that they know is bad for them? Dr. Balodis’ research targets understanding the motivational processes influencing this maladaptive decision-making; specifically this entails examining arousal, emotion and anticipation that direct behaviour. To that end, her investigations focus on how an individual forms preferences, assesses options and makes choices. This research approach cuts across traditional psychiatric boundaries and examines constructs such as impulsivity, thought to underlie many aspects of pathologic behaviour. Importantly, many motivational influences may be unavailable to the conscious awareness of the individual; her work therefore applies diverse methodologies targeting automatic or unconscious processes, including implicit learning tasks, psychophysiological measures and brain imaging techniques. As such, Dr. Balodis’ research samples not only from substance-dependent populations, but also from individuals with gambling disorder (the first ‘non-substance’-based addiction), at-risk or adolescent populations (notorious for making poor/risky decisions), as well as individuals suffering from obesity. Taken together, this research program establishes how reward and stress system alterations relate to motivation and decision-making in addiction. Dr. Balodis integrates behavioural research with neuroimaging, psychophysiological and clinical approaches across multiple conditions, with the goal of explaining and possibly modifying the mechanisms for change.
Specific areas of interest and contributions:
- The neurobiology of pathological gambling/gambling disorder
In one of the first studies examining anticipatory processing in a population of individuals with pathological gambling (PG), Dr. Balodis and colleagues found reduced ventral striatal activity during reward anticipation relative to healthy controls; importantly this ventral striatal activity negatively correlated with impulsivity – a key feature in PG (Balodis et al., 2012a); this work also emphasizes the importance of distinguishing functional roles of striatal subregions (Balodis et al., 2012b). Reduced ventral striatal responsiveness may reflect elevated impulsivity and could influence decision-making and/or reward-seeking behaviours. These findings are consistent with results in individuals with alcohol-dependence, but, in the case of PG, represent a unique opportunity to examine anticipatory processes without the confounding effect of a drug present. This work provides evidence for similar neural alterations in anticipatory processing across substance-related and non-substance-related addictions. She has since written a systematic review on this topic integrating findings into the larger addiction literature (Balodis & Potenza, 2015).
- Balodis, I.M., Kober, H., Worhunsky, P.D., Stevens, M.C., Pearlson, G.D. & Potenza, M.N. (2012a). Diminished fronto-striatal activity during processing of monetary rewards and losses in pathological gambling, Biological Psychiatry, 71: 749-57.
- Balodis, I.M., Kober, H., Worhunsky, P.D., Stevens, M.C., Pearlson, G.D. & Potenza, M.N. (2012b). Attending to striatal ups and downs in addictions. Biological Psychiatry, 72: e25-6.
- Balodis, I.M. & Potenza, M.N. (2015). Anticipatory reward processing in addicted populations: a focus on the Monetary Incentive Delay Task. Biological Psychiatry, 77(5):434-444.
- fMRI of Binge Eating Disorder
Dr. Balodis’ work also extends to fMRI investigations in obesity to identify meaningful subgroups in obese individuals based on biobehavioural differences. These studies examine obese individuals with binge eating disorder (BED), as well as obese individuals without BED, and healthy-weight comparison groups. During a cognitive control task, BED individuals were distinguished by relative hypoactivity brain areas implicated in self-regulation – the ventromedial prefrontal cortex and inferior frontal gyrus (Balodis et al., 2013a). During anticipatory processing, the BED group demonstrated diminished ventral striatal activity (Balodis et al., 2013b), which was further related to binge eating status at the end of a treatment trial (Balodis et al., 2014). Altogether, this work provides evidence for divergent neural substrates underlying reward processing and cognitive control across obese sub-types. In 2015, Dr. Balodis and colleagues published the first systematic review of neuroimaging studies in BED (Balodis et al., 2015).
- Balodis, I.M., Molina, N.D., Kober, H., Worhunsky, P.D. White, M.A., Sinha, R., Grilo, C.M., & Potenza, M.N. (2013a) Divergent neural substrates of inhibitory control in binge eating disorder relative to other manifestations of obesity, Obesity 21(2):367-77.
- Balodis, I.M., Kober, H., Worhunsky, P.D. White, M.A., Stevens, M., Pearlson, G., Sinha, R., Grilo, C.M., & Potenza, M.N. (2013b) Monetary reward processing in obese individuals with and without binge eating disorder, Biological Psychiatry, 73(9):877-86.
- Balodis, I.M., Grilo, C.M., Kober, H., Worhunsky, P.D. White, M.A., Stevens, M., Pearlson, G., & Potenza, M.N. (2014). A pilot study linking reduced fronto-striatal recruitment during reward processing to persistent bingeing following treatment for binge-eating disorder. International Journal of Eating Disorders, 47:376-384.
- Balodis, I.M., Grilo, C.M. & Potenza, M.N. (2015). Neurobiological features of binge eating disorder. CNS Spectrums, 20(6) 557-65.
- Stress and Alcohol Interactions
Dr. Balodis’ research program also investigates the influences of negative affect through stress reactivity as well as stress-alcohol interactions. Findings from this work demonstrate that anticipatory processing in the stress system can be used to gauge homeostatic processing and predict subsequent stress responses (Balodis et al., 2010). Perhaps not surprisingly, acute alcohol intoxication reduces both physiological and subjective responses to stress; however the expectation of consuming alcohol (i.e. a placebo group) also reproduces many of these effects (Balodis et al., 2011). These findings underscore the importance of anticipatory processes and suggest that some stress-dampening effects of alcohol may represent conditioned responses to cues predicting intoxication. Although this work did not detect an effect on risk-taking behaviour, another study examining biomarker responses to an intoxicating dose of alcohol, showed that trait impulsivity correlates with increases in the hormone cortisol (Magrys et al., 2013).
- Balodis, I.M., Wynne-Edwards, K.E. & Olmstead, M.C. (2010). The other side of the curve: examining the relationship between pre-stressor physiological responses and stress reactivity, Psychoneuroendocrinology, 35:1363-73.
- Balodis, I.M. Wynne-Edwards, K. & Olmstead, M.C. (2011). The Stress Response Dampening Effect of Placebo, Hormones and Behavior, 59: 465-472.
- Magrys, S., Wynne-Edwards, K. Olmstead, M.C. & Balodis, I.M. (2013) Biochemical responses to alcohol in healthy males: A role for individual differences. Psychophysiology, 50(2):204-9.
• (PhD), (Queen’s University), (2008)
• (Residency), (University), (Year)
• (Internship), (University), (Year)
• Anxiety Disorders
• Collaborative Mental Health Care
• Emergency Psychiatric Care
• Child & Youth Mental Health
• Forensics Psychiatry
• General Psychiatry
• Seniors Mental Health
• Global Mental Health –Local or International
• Mood Disorders
• Psychiatry and Medicine/CL
• Women's Health Concerns