Enhancing transdiagnostic mechanisms of cognitive dyscontrol using computer-based training

情绪、焦虑和创伤性应激障碍是常见的精神疾病--影响着美国超过4000万人。 成人--并且是全世界残疾的主要原因。患有这些疾病的人通常会受到 难以控制令人痛苦的个人思想和记忆，统称为重复的负面情绪 思考症状。模型表明，重复的负面思维是由执行功能缺陷驱动的， 以至于认知资源不足以抑制不想要的想法。执行功能缺陷 可能是一个有希望的治疗目标，但通常不会通过现有的干预措施得到解决。长期的 这项提议提出的目标是开发有效的、机械性的认知训练计划，以提高 认知和减少与情绪、焦虑和创伤性应激障碍相关的症状。目标 这一建议首先确定了认知训练计划的最佳剂量，旨在提高 这一人群的执行功能使用行为和神经结果(R61)。如果认知训练 在R61中测试成功地改善了执行功能(通过/不通过决策)，我们将评估 执行功能改变与临床症状改变的关系(R33)。我们的中央 假设反复训练练习将增强执行功能，并将导致减少 情绪、焦虑和创伤性应激障碍中的重复消极思维。这一假设将通过以下方式进行检验 追求两个具体目标：目标1是确定认知训练的认知效果和最佳剂量。目标2 是评估优化的认知训练方案相对于假条件的临床效果。我们会 还进行了一项探索性目标，以确定认知训练对现实世界认知的泛化 性能。R61阶段将通过随机选择患有抑郁症、焦虑症和/或 创伤性应激障碍患者可能需要接受两种剂量的认知训练或不接受治疗的对照条件之一。我们会 用认知任务表现和功能神经成像检查执行功能的变化 评估。R33阶段将参与者随机分配到由R61或假条件决定的剂量。 R33计划复制对执行功能的影响，并评估变化之间的关系 在执行功能和临床症状方面。我们将探索认知训练如何帮助人们在日常生活中 生活方式是通过智能手机移动认知测试应用程序进行评估。建议的研究是 创新是因为它旨在通过干预被认为能产生的认知目标来解决症状 多种疾病的症状，从而明确测试认知和情绪症状之间的相互作用。 这项拟议研究的成果将包括一项新的治疗计划和关于其 对减轻临床症状的效用。从这项建议中获得的知识将使我们的治疗方案 针对特定的认知系统，为以神经科学为基础的治疗替代方案提供基础 症状包括情绪、焦虑和创伤性应激障碍。

Mood, anxiety, and traumatic stress disorders are common psychiatric conditions - affecting over 40 million U.S. adults - and are leading causes of disability worldwide. People with these conditions are commonly plagued by difficulty controlling distressing personal thoughts and memories, collectively referred to as repetitive negative thinking symptoms. Models suggest that repetitive negative thinking is driven by executive functioning deficits, such that cognitive resources are insufficient to downregulate unwanted thoughts. Executive functioning deficits could be a promising treatment target but are not typically addressed with existing interventions. The long-term goal advanced by this proposal is to develop effective, mechanistic cognitive training programs that can improve cognition and reduce symptoms associated with mood, anxiety, and traumatic stress disorders. The objectives of this proposal are first to determine the optimal dose of a cognitive training program designed to improve executive functioning in this population using behavioral and neural outcomes (R61). If the cognitive training tested in the R61 successfully improves executive functioning (go/no-go decision), we will evaluate the relationship between change in executive functioning and change in clinical symptoms (R33). Our central hypothesis is that repeated training exercises will enhance executive functioning and will lead to a reduction of repetitive negative thinking in mood, anxiety, and traumatic stress disorders. The hypothesis will be tested by pursing two specific aims: Aim 1 is to identify the cognitive effects and optimal dose of cognitive training. Aim 2 is to evaluate the clinical effects of the optimized cognitive training program relative to a sham condition. We will also conduct an exploratory aim to determine generalization of cognitive training to real-world cognitive performance. The R61 phase will test Aim 1 by randomizing participants with depression, anxiety, and/or traumatic stress disorders to one of two doses of cognitive training or a no-treatment control condition. We will examine executive functioning change with cognitive task performance and functional neuroimaging assessments. The R33 phase will randomize participants to the dose decided by the R61 or a sham condition. The R33 intends to replicate the impact on executive functioning and assess the relationship between change in executive functioning and clinical symptoms. We will explore how cognitive training helps people in their daily lives by including assessments given with a smartphone mobile cognitive testing app. The research proposed is innovative because it aims to address symptoms by intervening on a cognitive target thought to generate symptoms across multiple disorders, thus explicitly testing the interactions of cognitive and emotional symptoms. Outcomes derived from the proposed research will include a novel treatment program and information about its utility for reducing clinical symptoms. Knowledge from this proposal will advance our treatment options by targeting a specific cognitive system, providing a foundation for neuroscience-based therapeutic alternative for symptoms that span mood, anxiety, and traumatic stress disorders.