Targeted Intervention for Adolescents following Child Maltreatment: Examining Neural and Behavioral Mechanisms within the Positive Valence System

项目总结 国家数据显示，超过65万名儿童和青少年暴露在身体、性或 每年的情感虐待或身体或情感上的忽视。此外，有童年历史的青年 虐待(CM)患抑郁症的可能性至少是前者的两倍，而且非 对当前最佳实践抑郁干预措施的反应(即认知行为疗法和 抗抑郁药)与未受虐待的同龄人进行比较。研究表明，CM会增加患抑郁症的风险 通过正价系统的中断，如奖赏处理和行为激活(BA) 可能是针对这些缺陷的另一种抑郁干预措施。这项提议采取了创新的 集成神经、行为和新型移动技术的方法来测量纵向变化 奖赏加工是有抑郁病史青少年BA干预反应的一种机制 在CM中。这项提议的K23为候选人在环境、生物和情感方面的先前培训架起了桥梁 通过1)目标集中干预的新培训促进青少年抑郁的病因过程 研究，2)发展情感神经科学，3)以技术为基础的评估工具。这次培训 将独一无二地定位候选人，以研究多个级别的干预反应的生物标志物 分析，重点是易受伤害的青年处于干预风险中的无反应。具体地说，抑郁 有CM病史的青少年将完成BA干预前后的fMRI和行为测量 奖励处理以及对身体(步骤)和社交(文本数量， 电话、社交媒体使用)活动，以确定1)BA如何针对神经和行为奖励处理 和真实世界的行为参与(具体目标1)，以及2)神经和行为是否发生变化 奖励处理预测干预反应和维持(具体目标2)。 为了实现这些研究和培训目标，应聘者将接受理想中的培训 在一个最佳的科学培训环境中的导师团队。麦考利医生是病因学方面的专家 治疗青少年抑郁症，并制定了以增加奖励为目标的BA方案 专门针对青少年的回避经历和减少。麦克劳克林博士拥有丰富的专业知识 发展情感神经科学和使用功能磁共振成像方法学研究神经回路相关的 遭受虐待的青少年的情感和奖赏加工。Arán博士还提供了其他 有针对性的抑郁症干预研究方面的专业知识，以及在使用 移动技术可评估实时行为、情感和心理健康状况。培训和研究活动 将使候选人做好准备，以实现开发更大研究计划的职业目标 通过研究创新的生物标志物，为NIMH战略研究重点的目标3做出贡献 干预应对，努力为弱势人群量身定做干预措施并优化结果。

PROJECT SUMMARY National data indicate over 650,000 children and adolescents are exposed to physical, sexual, or emotional abuse or physical or emotional neglect each year. Moreover, youth with a history of childhood maltreatment (CM) are at least twice as likely to develop depression and are at substantial risk for non- response to current best practice depression interventions (i.e., cognitive behavioral therapy and antidepressants) compared to non-maltreated peers. Research suggests that CM increases risk for depression through disruptions in the positive valence system, such as reward processing, and Behavioral Activation (BA) may be an alternative depression intervention that targets these deficits. This proposal takes an innovative approach integrating neural, behavioral, and novel mobile technologies to measure longitudinal change in reward processing as a mechanism of BA intervention response among depressed adolescents with a history of CM. This proposed K23 bridges the candidate's prior training in environmental, biological, and affective etiological processes contributing to adolescent depression with new training in 1) target-focused intervention research, 2) developmental affective neuroscience, and 3) technology-based assessment tools. This training will uniquely position the candidate to investigate biomarkers of intervention response across multiple levels of analysis, with an emphasis on vulnerable youth at risk for intervention non-response. Specifically, depressed adolescents with a history of CM will complete pre- and post- BA intervention fMRI and behavioral measures of reward processing along with daily passive mobile monitoring of physical (steps) and social (amount of texts, calls, social media usage) activity to determine 1) how BA targets neural and behavioral reward processing and real-world behavioral engagement (Specific Aim 1), and 2) whether change in neural and behavioral reward processing predicts intervention response and maintenance (Specific Aim 2). To achieve these research and training goals, the candidate will receive training from an ideal mentorship team within an optimal scientific training environment. Dr. McCauley is an expert in the etiology and treatment of adolescent depression and developed a BA protocol targeting the increase of rewarding experiences and decrease of avoidance specific to adolescents. Dr. McLaughlin has significant expertise in developmental affective neuroscience and the use of fMRI methodology to study neural circuitry related to affective and reward processing among youth exposed to maltreatment. Dr. Areán provides additional expertise in target-focused depression intervention research as well as extensive experience in the use of mobile technologies to assess real-time behavior, affect, and mental health. Training and research activities will prepare the candidate to achieve the career objective of developing a larger program of research contributing to Objective 3 of NIMH Strategic Research Priorities by investigating innovative biomarkers of intervention response in an effort to tailor interventions and optimize outcomes in vulnerable populations.