A randomized controlled trial examining the impact of a brief attention-based neurobehavioral transdiagnostic intervention on acute fear response

项目摘要/摘要 尽管经过几十年的研究，目前设计用于治疗各种精神疾病的心理治疗 并不是对所有接受它们的人都有效。具体地说，得到良好支持的精神疾病治疗 涉及恐惧(例如，创伤后应激障碍、恐慌)似乎对大多数人有效，但始终留下 “治疗无效者”组。对观察到的治疗差异的一个可能的解释 反应可能是现代心理治疗的重点，以缓解特定类型的症状 诊断，而不是个人为什么会出现症状的潜在机制。最近， 以恐惧为基础的心理障碍(如创伤后应激障碍、特定恐惧症、惊恐障碍、社交焦虑) 被识别为共享一组不同的生物标志物，包括急性恐惧的遗传生物标志物(即 瞬间)和注意力控制障碍。因此，神经行为干预是一种很有希望的 一类旨在针对可能维持各种疾病症状的生物标志物的治疗方法 心理障碍。注意力训练技术(ATT)是一种神经行为干预，它具有 通过证明其在减少各种不同疾病的症状方面的有效性而获得关注 心理诊断。虽然以成熟的理论为基础，但ATT的变化机制是 很大程度上是未知的。一种提出的机制可能是ATT促进了 大脑中涉及自上而下的注意力执行控制的区域(腹内侧额前皮质 [vmPFC]和背外侧前额叶皮质[dlPFC])和自下而上的注意网络(背侧前 扣带回[dACC]和杏仁核)，导致对潜在问题的自上而下调节增加 自下而上的注意过程。自上而下和自下而上都涉及相同的大脑区域 注意过程也与恐惧反应(即惊吓反应)和恐惧学习有关 (即，一个人多快就知道一种刺激是安全的或令人恐惧的)。总而言之，这项研究表明 通过增加对注意力的执行控制，急性恐惧反应可能会减少 参与ATT。拟议的随机临床试验将测试一种自我给药的简明 增加注意力控制的神经生物干预(ATT)将减少急性恐惧反应，并且 此更改是否与通过行为代理衡量的标准dACC功能相关。它是 预计从事ATT的人将表现出更大的注意控制效率，这将降低 他们敏锐的恐惧反应。还预计那些从事ATT的人也将表现出更大的dAcc 功能，通过行为代理来衡量，并将表现出他们报告的恐惧减少，因为他们的注意力 在干预过程中，控制权有所增加。此外，预计干预(ATT)将 通过识别的心理诊断间接减少基于绝对恐惧的症状 生物标记物(即注意控制、dACC功能、急性恐惧反应)以减少报告的症状。

Project Summary/Abstract Despite decades of research, current psychological treatments designed to treat a variety of mental illnesses are not effective for all who receive them. Specifically, well-supported treatments for mental illnesses that involve fear (e.g., PTSD, panic) appear to be effective for the majority of individuals, but consistently leave a group of “treatment non-responders.” One potential explanation for the observed discrepancy in treatment response may be the focus of modern psychotherapies on relieving symptoms specific to categorical diagnoses, rather than mechanisms underlying why the individual is experiencing the symptoms. Recently, fear-based psychological disorders (e.g., PTSD, specific phobia, panic disorder, social anxiety) have been identified as sharing a distinct set of biomarkers, including genetic biomarkers of acute fear (i.e., fear in the moment) and impairments in controlling attention. Neurobehavioral interventions are therefore a promising class of treatments designed to target the biological markers that may be maintaining the symptoms of various psychological disorders. The Attention Training Technique (ATT) is a neurobehavioral intervention that has garnered attention through its demonstrated effectiveness in reducing symptoms across a variety of psychological diagnoses. While grounded in well-established theory, the mechanisms of change in ATT are largely unknown. One proposed mechanism may be that ATT promotes functional connectivity between regions in the brain implicated in top-down executive control over attention (ventromedial prefrontal cortex [vmPFC] and dorsolateral prefrontal cortex [dlPFC]) and bottom-up attention networks (dorsal anterior cingulate cortex [dACC] and amygdala), resulting in increased top-down regulation of potentially problematic bottom-up attentional processes. The same brain regions implicated in both top-down and bottom-up attentional processes have also been associated with fear responding (i.e., startle response) and fear learning (i.e., how quickly one learns that a stimuli is safe or to be feared). Taken together, the research suggests that acute fear responding may be decreased through increased executive control over attention through engagement in ATT. The proposed randomized clinical trial will test whether a self-administered brief neurobiological intervention (ATT) to increase attentional control will decrease acute fear responding, and whether this change is associated with normative dACC functioning, measured by behavioral proxy. It is expected that those who engage in ATT will show greater attentional control efficiency, which will decrease their acute fear response. It is also expected that those who engage in ATT will also show greater dACC functioning, measured by behavioral proxy and will exhibit decreases in their reported fear as their attentional control increases over the course of the intervention. Additionally, it is expected that the intervention (ATT) will indirectly decrease symptoms of categorical fear-based psychological diagnoses through the identified biomarkers (i.e., attentional control, dACC functioning, acute fear response) to decrease reported symptoms.