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

一项随机对照试验，研究基于短暂注意力的神经行为跨诊断干预对急性恐惧反应的影响

• 批准号: 10291622
• 负责人: HOLLY K ORCUTT
• 金额: $ 42.62万
• 依托单位: NORTHERN ILLINOIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10291622
• 关键词: Acute; Amygdaloid structure; Anterior; Anxiety; Anxiety Disorders; Area; Attention; Attentional deficit; Behavioral; Biological; Biological Markers; Blinking; Brain; Brain region; Categories; Conditioned Stimulus; Data; Data Reporting; Development; Diagnosis; Diagnostic; Dimensions; Disease; Dorsal; Down-Regulation; Effectiveness; Exhibits; Fright; Functional disorder; Genetic Markers; Impairment; Individual; Intervention; Learning; Link; Maintenance; Measures; Mental Depression; Mental disorders; Modernization; Neurobiology; Neurologic; Panic; Panic Disorder; Pathologic; Patient Self-Report; Patients; Phenotype; Phobias; Physiology; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Proxy; Psychopathology; Psychotherapy; Randomized Clinical Trials; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Domain Criteria; Risk Factors; Sampling; Self Administration; Short-Term Memory; Source; Specific Phobia; Startle Reaction; Stimulus; Symptoms; System; Testing; Training Technics; Trauma; attentional control; base; behavior measurement; cingulate cortex; cognitive function; conditioned fear; design; effective therapy; endophenotype; executive function; experience; improved; neurobehavioral; neuroimaging; novel; post intervention; post-traumatic symptoms; psychologic; public health relevance; reduce symptoms; response; smartphone Application; social anxiety; theories; therapy design; treatment group; treatment response; undergraduate student

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.

项目总结/摘要 尽管经过几十年的研究，目前的心理治疗，旨在治疗各种精神疾病， 并不是对所有接受者都有效。具体来说，得到充分支持的精神疾病治疗方法， 涉及恐惧（例如，创伤后应激障碍，恐慌）似乎是有效的，为大多数人，但始终留下一个 “治疗无反应者”。观察到的治疗差异的一种可能解释是 反应可能是现代心理治疗的重点， 诊断，而不是为什么个人正在经历的症状的机制。最近， 基于恐惧的心理障碍（例如，创伤后应激障碍，特定恐惧症，恐慌症，社交焦虑）已经被 被鉴定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，恐惧 注意力控制的障碍。因此，神经行为干预是一种很有前途的 这类治疗旨在靶向可能维持各种疾病症状的生物标志物， 心理障碍注意力训练技术（ATT）是一种神经行为干预， 通过其在减少各种症状方面的有效性获得了关注， 心理诊断虽然建立在成熟的理论基础上，ATT的变化机制是 大部分未知。一种建议的机制可能是ATT促进了 大脑中涉及自上而下的对注意力的执行控制的区域（腹内侧前额叶皮层 [vmPFC]和背外侧前额叶皮层[dlPFC]）和自下而上的注意网络（背前 扣带皮层[dACC]和杏仁核），导致对潜在问题的自上而下的调节增加， 自下而上的注意过程同样的大脑区域参与了自上而下和自下而上 注意力过程也与恐惧反应相关（即，惊吓反应）和恐惧学习 (i.e.,一个人学习刺激是安全的或令人恐惧的速度有多快）。综合来看，研究表明， 急性恐惧反应可以通过增加对注意力的执行控制来减少， 参与ATT。拟议中的随机临床试验将测试自我管理的简短 神经生物学干预（ATT）增加注意力控制将减少急性恐惧反应， 这种变化是否与正常的dACC功能有关，通过行为代理来衡量。是 预计那些从事AT的人将表现出更高的注意力控制效率，但注意力控制效率会下降 他们的恐惧反应还预计那些从事ATT的人也会表现出更大的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，控制力会增强。此外，预计干预措施（ATT）将 通过确定的因素间接减少基于恐惧的明确心理诊断的症状 生物标志物（即，注意力控制，dACC功能，急性恐惧反应），以减少报告的症状。