Rakesh Jetly

Royal Ottawa Mental Health Centre · Department of Psychiatry

Chronic pain is a pervasive condition that involves complex neurobiological mechanisms and frequently co-occurs with mental health challenges such as anxiety, depression, and posttraumatic stress disorder (PTSD), interacting significantly with psychiatric outcomes. Despite its prevalence, the neural mechanisms of chronic pain and its interactions w...

Concussion is a public health crisis which results in a complex cascade of neurochemical changes that can have life changing consequences. Subconcussions are generally considered less serious, but we now realise repetitive subconcussions can lead to serious neurological deficits. Subconcussions are common in contact sports, and the military where c...

Psilocybin is a classic psychedelic with demonstrated preliminary clinical efficacy in a range of psychiatric disorders. Evaluating the impact of psilocybin on cognitive function is essential to unravel its potential benefits and risks. In this systematic review, we assessed psilocybin's effect on cognitive function through a comprehensive search o...

La rétroaction neurologique apparaît comme un traitement psychophysiologique qui permet l’autorégulation par la rétroaction en ligne des états neuronaux. Les nouvelles approches de médecine personnalisée sont particulièrement importantes pour le traitement du syndrome de stress post-traumatique (SSPT), car la présentation des symptômes et les répon...

Neurofeedback is emerging as a psychophysiological treatment where self-regulation is achieved through online feed-back of neural states. Novel personalized medicine approaches are particularly important for the treatment of posttrau-matic stress disorder (PTSD), as symptom presentation of the disorder, as well as responses to treatment, are highly...

The clinical presentation and neurobiology of mild traumatic brain injury (mTBI) - also referred to as concussion - are complex and multifaceted, and interrelationships between neurobiological measures derived from neuroimaging are poorly understood. This study applied machine learning (ML) to multimodal whole-brain functional connectomes from magn...

Background Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions fo...

Aside from personal impacts, costs to employers and national economies of mental health can be measured in trillions of dollars. With volatility, uncertainty, complexity and ambiguity increasingly describing the new normal workplace, the need for evidence-based interventions for sustained mental health at work to be developed, evaluated and impleme...

BACKGROUND Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions fo...

Introduction Real-time fMRI-based neurofeedback (rt-fMRI-NFB) is a non-invasive technology that enables individuals to self-regulate brain activity linked to neuropsychiatric symptoms, including those associated with post-traumatic stress disorder (PTSD). Selecting the target brain region for neurofeedback-mediated regulation is primarily informed...

Direct eye contact is essential to understanding others’ thoughts and feelings in social interactions. However, those with post-traumatic stress disorder (PTSD) and exposure to moral injury (MI) may exhibit altered theory-of-mind (ToM)/mentalizing processes and experience shame which precludes one’s capacity for direct eye contact. We investigated...

Background: Advanced neuroscientific insights surrounding post-traumatic stress disorder (PTSD) and its associated symptomatology should beget psychotherapeutic treatments that integrate these insights into practice. Deep Brain Reorienting (DBR) is a neuroscientifically-guided psychotherapeutic intervention that targets the brainstem-level neuroph...

Neural representations of sensory percepts and motor responses constitute key elements of autobiographical memory. However, these representations may remain as unintegrated sensory and motor fragments in traumatic memory, thus contributing toward re-experiencing and reliving symptoms in trauma-related conditions such as post-traumatic stress disord...

Microglia are immune brain cells implicated in stress-related mental illnesses including posttraumatic stress disorder (PTSD). Their role in the pathophysiology of PTSD, and on neurobiological systems that regulate stress, is not completely understood. We tested the hypothesis that microglia activation, in fronto-limbic brain regions involved in PT...

In this chapter, the central elements of Moral Injury—moral beliefs, potentially moral injurious events, and moral suffering—are discussed with reference to the relevant literature. Keeping these elements in mind, an overview was provided of assessments as well as therapeutic approaches. Two case reports illustrate how guilt and shame, when left un...

Collective research has identified a key electroencephalogram (EEG) signature in patients with posttraumatic stress disorder (PTSD), consisting of abnormally reduced alpha (8-12 Hz) rhythms. We conducted a 20-session, double-blind, randomized controlled trial of alpha-desynchronizing neurofeedback in patients with PTSD over 20-weeks. Our objective...

Background: Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-time functional magnetic resonance imaging (fMRI) and electroencephalography neurofeedback studies suggest that regulating posterior cingulate cor...

LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of events that deeply transgress a person’s core moral beliefs and values. Such events are reportedly common in the military context, and strong associations have been demonstrated between exposure to potentially morally injurious events (PMIEs) and suicidality. This study ex...

BACKGROUND The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID cases and COVID-related deaths among residents of long-term care facilities (LTCF; also known as centres d’hébergement et de soins de longue durée [CHSLD] in Québec). As part of Canada’s response to the COVID-19 pandemic, Canadian Armed Force...

Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID cases and COVID-related deaths among residents of long-term care facilities (LTCF). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to...

LAY SUMMARY There has been increasing interest in understanding the impact of blast exposure on health and performance in military members and Veterans. This phenomenon has proven difficult to study because personnel diagnosed with blast-induced mild traumatic brain injury (mTBI) typically also exhibit emotional difficulties such as posttraumatic s...

Cortical gyrification, as a specific measure derived from magnetic resonance imaging, remains understudied in mild traumatic brain injury (mTBI). Local gyrification index (lGI) and mean curvature are related measures indexing the patterned folding of the cortex,ml which reflect distinct properties of cortical morphology and geometry. Using both met...

Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one's moral beliefs. The...

Military Breachers and Range Staff (MBRS) are subjected to repeated sub-concussive blasts, and they often report symptoms that are consistent with a mild traumatic brain injury (mTBI). Biomarkers of blast injury would potentially aid blast injury diagnosis, surveillance and avoidance. Our objective was to identify plasma metabolite biomarkers in mi...

LAY SUMMARY Moral injury (MI) refers to the psycho-spiritual consequences of extremely challenging events that threaten one’s moral beliefs and core values. MI is characterized by intense shame, guilt, anger, loss of trust in oneself and others, and social withdrawal — factors that may impede a person’s willingness to seek help for mental health pr...

Les Forces armées canadiennes (FAC) ont déployé 2 595 membres de la Force régulière et de la Force de réserve dans le cadre de l’Opération LASER (Op LASER), la mission des FAC destinée à soutenir le personnel civil des établissements de soins de longue durée en Ontario et des centres d’hébergement et de soins de longue durée au Québec. Les membres...

The Canadian Armed Forces (CAF) deployed 2595 regular and reserve force personnel on Operation (Op) LASER, the CAF’s mission to provide support to civilian staff at longterm care facilities in Ontario and in the Centres d’hébergement de soins de longue durée in Quebec. An online longitudinal survey and in-depth virtual discussions were conducted by...

Background: A moral injury occurs when a deeply held moral code has been violated, and it can lead to the development of symptoms of posttraumatic stress disorder (PTSD). However, the neural correlates that differentiate moral injury and PTSD remain largely unknown. Intrinsic connectivity networks such as the default mode network (DMN) appear to b...

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that results from exposure to traumatic event(s). Decreased astrocyte-related proteins (e.g., glial fibrillary acidic protein, GFAP) and atrophic astrocytes in corticolimbic brain areas implicated in PTSD have been reported in experimental models suggesting that astrocyt...

Background Intrinsic connectivity networks, including the default mode network (DMN), are frequently disrupted in individuals with posttraumatic stress disorder (PTSD). The posterior cingulate cortex (PCC) is the main hub of the posterior DMN, where the therapeutic regulation of this region with real-time fMRI neurofeedback (NFB) has yet to be expl...

Background: The impacts of the COVID-19 pandemic have disproportionally affected different population groups. Veterans are more likely to have pre-existing mental health conditions compared to the general Canadian population, experience compounded stressors resulting from disruptions to familial, social, and occupational domains, and were faced wi...

BACKGROUND The COVID-19 pandemic has resulted in significant changes to everyday life, including social distancing mandates, changes to health care, and a heightened risk of infection. Previous research has shown that Canadian Armed Forces (CAF) Veterans are at higher risk of developing mental and physical health conditions. Veterans and their fami...

Background: The COVID-19 pandemic has resulted in significant changes to everyday life, including social distancing mandates, changes to health care, and a heightened risk of infection. Previous research has shown that Canadian Armed Forces (CAF) Veterans are at higher risk of developing mental and physical health conditions. Veterans and their fa...

Background: Research is urgently needed to understand health care workers' (HCWs') experiences of moral-ethical dilemmas encountered throughout the COVID-19 pandemic, and their associations with organizational perceptions and personal well-being. This research is important to prevent long-term moral and psychological distress and to ensure that wo...

Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the...

LAY SUMMARY In 2015, the Canadian Armed Forces (CAF) implemented Operation HONOUR to eliminate sexual misconduct (SM) in the military. Sexual assault, inappropriate sexual behaviours, sexual harassment, and gender discrimination are all types of SM. Experiencing SM can result in depression, substance abuse, physical health problems, and even posttr...

Background: Healthcare workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, re-deployment, and changes in organizational mandates often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections, worrying about infec...

BACKGROUND Health care workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, redeployment, and changes in organizational mandates, often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections; worrying about infect...

Objective This study describes patterns of distress associated with exposure to potentially morally injurious experiences (PMIEs) in a Canadian military sample. Method Thematic analysis was performed on interviews from PMIE-exposed military members and Veterans. Participants also completed structured diagnostic interviews, and measures of trauma e...

Post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent and closely related disorders. Affected individuals often exhibit substantially overlapping symptomatology – a major challenge for differential diagnosis in both military and civilian contexts. According to our symptom assessment, the PTSD group exhibi...

Objectives The need for remote delivery of mental health interventions including instruction in meditation has become paramount in the wake of the current global pandemic. However, the support one may usually feel within the physical presence of an instructor may be weakened when interventions are delivered remotely, potentially impacting one’s med...

Background The impacts of the COVID-19 pandemic have disproportionally affected different population groups. Veterans are more likely to have pre-existing mental health conditions compared to the general Canadian population, experience compounded stressors resulting from disruptions to familial, social, and occupational domains, and were faced with...

Objectives The current study was designed to replicate and extend previous findings that demonstrate the efficacy of virtual reality (VR) technology to facilitate salient experiences of positive affect and wellbeing in response to meditative tasks, by (1) evaluating the phenomenological variables vividness, egocentricity, and immersiveness, as medi...

LAY SUMMARY Moral injury (MI) refers to the distress experienced when people do, or do not, do something that goes against their morals or values. It can also occur when people perceive that their values have been betrayed. MI is associated with several mental health conditions, including posttraumatic stress disorder (PTSD), depression, and anxiet...

Within the past decade, the emerging field of moral injury has focused mostly on the clinical dimension of a traumatic event (Griffin et al., Journal of Traumatic Stress, 2019, 32, p. 350). This article will present a character dimension of moral injury and briefly introduce a dual pathway model of moral injury reflecting clinical and character dim...

Objective: Research is urgently needed to understand health care workers' (HCWs') experiences of moral-ethical dilemmas encountered throughout the COVID-19 pandemic, and their associations with organizational perceptions and personal well-being. The purpose of this research is to evaluate associations between workplace experiences during COVID-19,...

Background Post-traumatic stress disorder (PTSD) is a debilitating mental health condition that develops in response to exposure to a traumatic event. The purpose of this study was to investigate white matter differences using diffusion tensor imaging (DTI) in trauma exposed military personnel with and without PTSD. Methods Data were acquired in c...

Introduction Recently, there has been increasing concern about the adverse health effects of long-term occupational exposure to low-level blast in military personnel. Occupational blast exposure occurs routinely in garrison through use of armaments and controlled blast detonations. In the current study, we focused on a population of breaching instr...

Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder, particularly among military personnel and veterans. Cortical gyrification, as a specific metric derived from structural MRI, is an index of the convoluted folding and patterning of the gyri and sulci, and is thought to facilitate the efficiency of local neuronal wiring. It h...

Objective Mental health among military personnel is an important public health priority. It is known that military personnel experience a high prevalence of child maltreatment and deployment-related traumatic events (DRTEs) and both are related to mental health outcomes. However, few, if any, studies have examined the cumulative and interactive eff...

Background Moral injury (MI) is consistently associated with adverse mental health outcomes, including the development of posttraumatic stress disorder (PTSD) and suicidality. Methods We investigated neural activation patterns associated with MI event recall using functional magnetic resonance imaging in participants with military and public safet...

Currently, there is strong interest within the military to better understand the effects of long-term occupational exposure to repeated low-level blast on health and performance. To gain traction on the chronic sequelae of blast, we focused on breaching—a tactical technique for gaining entry into closed/blocked spaces by placing explosives and main...

Objective The present study explores the effectiveness of incorporating temporal information in predicting Post-Traumatic Stress Disorder (PTSD) severity using magnetoencephalography (MEG) imaging data. The main objective was to assess the relationship between longitudinal MEG functional connectome data, measured across a variety of neural oscillat...

The need for research to advance scientific understanding must be balanced with ensuring the rights and wellbeing of participants are safeguarded, with some research topics posing more ethical quandaries for researchers than others. Moral injury is one such topic. Exposure to potentially morally injurious experiences can lead to significant distres...

Objective: We investigate the potential therapeutic application of virtual reality (VR) technology as an aid to meditation practice among persons varying in posttraumatic stress disorder (PTSD) symptoms. Method: In this within-group mixed-methods study, 96 young adults practiced both VR- and non-VR-guided meditations and reported on their experien...

BACKGROUND Military members (MMs), including Canadian Armed Forces (CAF) Service members (SMs), and Veterans are at elevated risk of experiencing occupational traumas which can cause operational stress injuries (OSIs) including post-traumatic stress disorder (PTSD), and moral injury (MI). Traditional evidence-based psychotherapeutic interventions c...

Background: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there ma...

Across three studies, we provide a proof-of-concept evaluation of an integrative psychotherapeutic application of virtual reality (VR) technology. Study 1 (n = 36) evaluated an unguided “safe-place” imagery task, where participants were instructed “to create a safe space… [such as] a scene, item, design, or any visual representation that makes you...

War metaphors are consistently utilized during times of adversity in popular culture, with the current global pandemic being no exception. This paper discusses use of war analogies to conjure images of bravery and sacrifice, while noting that these images tend to focus exclusively on the negative aspects of war. Taking analogies of war further, thi...