The Healing Power of a Smile

Dr. Milos R. Popovic and team study markers of a genuine smile, and how stimulating them can influence mood

As mental health struggles rise, teams of medical experts continue to explore alternative methods to treat patients in a safe and respectful manner. At the KITE Research Institute, a team led by Institute Director Dr. Milos R. Popovic is working to treat patients with major depressive disorder (MDD) by using a therapeutic method called Functional Electrical Stimulation Therapy (FEST).

Dr. Popovic's idea came from a book discussing the work of Dr. Paul Ekman, a psychologist who studied emotions and their relations to facial expressions. A short two-sentence passage about how Dr. Ekman's patients felt intense sadness after 15 minutes of frowning led Dr. Popovic to begin the Smile project.

First, a little background. There are two kinds of smiles: voluntary and genuine. A voluntary smile consists of movement of just the mouth. A genuine smile includes an involuntary muscle movement around the eyes and eyebrows called the Duchenne marker. Genuine smiles stem from feelings of positive emotion. Dr. Popovic shares that he wanted to see if stimulating the Duchenne marker would change the moods of individuals diagnosed with MDD, a complex mood disorder. Currently, there is no long–term cure for depression, only methods of managing symptoms.

The research for the Smile project began in 2013 when Dr. Popovic recruited Dr. José Zariffa to help him conduct a study using FEST. FEST uses electricity to stimulate muscles, causing them to contract. Stimulating weakened or paralyzed muscles while a patient attempts to contract those muscles works to retrain the central nervous system. In time, this can lead to a person regaining movement.

Patients know they are coming to an institution where they feel safe and comfortable. – Dr. Popovic

Much of Dr. Popovic's previous work contains the use of FEST to treat patients who have suffered a stroke, are diagnosed with Parkinson's disease or experience paralysis of the body. In Dr. Popovic and Dr. Zariffa's 2014 published study, they hypothesized that using FEST to stimulate the Duchenne marker would artificially induce positive emotions. This in turn may lead to a new method to treat symptoms of MDD.

The results of the 2014 study prompted Dr. Popovic to investigate further. As client assessments continued, participants expressed feeling more determined and less scared. It was these indicators of positive mood change that motivated Dr. Popovic to begin writing to grant agencies; however, he met with constant rejection.

Dr. Popovic recalls, “I got responses back that said, 'This is ridiculous,' 'You don't know how to handle psychiatric patients.'”

But Dr. Popovic pressed forward. It was the gift of generous donors – Dean Connor and Maris Uffelmann – that allowed Dr. Popovic to kickstart the next phase of his research. His team proposed their study to the KITE research ethics board, who with hesitation allotted the study ten hours per patient. Of the ten participants in Dr. Popovic's 2019 study, five requested an additional thirty sessions. Those five people found the therapy was improving their sleep and reducing feelings of sadness and guilt.

Today, Dr. Popovic and his team continue to further their research. Dr. Popovic is now working alongside psychiatrist Dr. Venkat Bhat as the project moves into clinical trials. The team is currently developing an at-home electrical stimulation therapy mask that modulates the Duchenne marker muscles. The goal is to provide MDD patients with an affordable and accessible treatment option.

Unlike medications and other forms of brain stimulation therapy, FEST is non-invasive and causes no side effects.

If successful, Dr. Popovic's device will allow patients the option to receive treatment without having to enter a clinical setting. Patients can be assessed from their homes and have a custom product sent to their front door. Because this treatment option can be done in the privacy of one's home, hopefully this will encourage more people to seek help. Dr. Popovic says that this could open the door for “other conditions that could be treated in this way that we have never thought about.”

I'm trying to use the nudging method to now help people who have depression. – Dr. Popovic

Since the publication of his 2019 study, public mental health has deteriorated significantly as a result of the COVID-19 pandemic, and includes a major rise in depression cases. With each lockdown and outbreak, a need for accessible mental health treatment increases. Dr. Popovic hopes that in the next few years his product will be available to the public and “that people can use [it], and if that helps, that would be fantastic.”

Dr. Popovic attributes KITE's support as an important factor in his successful research. He notes that KITE's involvement in the study came with three elements:

1. Capability

From the start, KITE gave Dr. Popovic the ability to assemble a team to support the study. The clinical setting established at KITE, and the support KITE gave, made a huge difference for patients. “[With] the proper treatment team and proper caring team [at KITE], patients know they are coming to an institution where they feel safe and comfortable.” When working on a project such as Smile, the confidence and caring aspect that KITE provided was essential.

2. Extraordinary people

Dr. Popovic recounts that his idea was consistently met with hesitancy and rejection. Gathering a team to execute this research successfully and safely meant finding people who were willing to take risks to further rehabilitation methods. Dr. Popovic states, “You need to have the scientists, intellectual capacity, to actually try something. To come up with something totally new and innovative, and then try it in a safe and respectful way.” The current success of Smile is in part due to Dr. Popovic's team taking a chance on an unusual idea – and that too is extraordinary.

3. Donations

KITE's reputation as a space that fosters knowledge and innovation helped legitimize Dr. Popovic's unorthodox idea. He describes the relationship between his research team, KITE and donors as a partnership where “you have a wonderful donor who for one reason or another trusts you and believes that you are genuine and what you're doing is making a difference and takes a leap of faith. Then you have excellent staff who can execute on a tight budget and are able to do that in the right way; these are all ingredients of a successful scientific experiment.” KITE's support of Dr. Popovic's idea is helping transform the treatment of major depressive disorder.

Rather than merely managing symptoms, Dr. Popovic remains focused on his patients' quality of life. As his team continues their work, Dr. Popovic looks towards the long-term success of FEST for stroke and paralysis patients. What his team is doing is taking an already successful treatment and using it in a new context. As Dr. Popovic likes to call it, “I have a nudging method, and I'm trying to use the nudging method to now help people who have depression, to nudge them out of it.”

KITE continues partnership with Centennial College

KITEworks Magazine is an annual collaborative project between Centennial College's Professional Writing-Communications and Photography programs and KITE. The stories, experiences and photographs shared in this year's edition of the magazine give an unfiltered look into how KITE has evolved to become a world leader in rehabilitation science. Come and explore how KITE works!