Sleep and Fear Extinction Learning among Adolescents with Anxiety or OCD

儿童焦虑症和强迫症（OCD）是普遍和有害的，然而， 接受一线治疗（认知行为疗法; CBT）的青少年不会 经历症状缓解。患有焦虑症和强迫症的年轻人报告睡眠问题的比例很高; 有证据表明，自我报告的睡眠相关问题预示着改善较慢， 临床结果的评估。关于睡眠的作用， CBT治疗期间的治疗性学习。该项目旨在通过整合这些差距， 多方法睡眠评估与恐惧消退学习，这是一个假定的机制， 在CBT治疗焦虑和/或强迫症中的作用。研究的目的是描述睡眠问题的特征， 样本的青年焦虑和/或强迫症，并检查睡眠变量之间的关联， 恐惧消退学习的心理生理学测量。中心方法论涉及多方法论 睡眠评估，包括自我报告测量、活动记录和夜间脑电图， 以及一项基于计算机的恐惧消退学习任务，其中包括测量皮肤电导 在84名青少年（13-17岁）与原发性焦虑或强迫症进入基于CBT的反应（SCR） 强化门诊计划。中心假设是，较短的睡眠量和较多的睡眠 干扰与心理生理反应有关，表明恐惧消退学习减少 在患有焦虑症和强迫症的青少年中减少了恐惧消退回忆。该项目的创新之处在于， 在患有焦虑和/或强迫症的青少年的临床样本中使用多方法睡眠评估， 小说此外，将睡眠测量与恐惧消退学习的心理生理学指标联系起来， 据我们所知，尚未对青年人进行临床抽样。未来的研究将调查这些 与整个CBT治疗过程中重复测量的相关性。如果成功，我们将 准备开发和测试针对睡眠特定方面的增强策略， 次优恐惧消退学习。最终，这项工作的结果可以作为概念验证， 确定睡眠目标，以指导焦虑和强迫症的行为治疗的增强。

Pediatric anxiety and Obsessive Compulsive Disorder (OCD) are prevalent and impairing, yet a significant subset of youth who receive the first-line treatment (Cognitive Behavioral Therapy; CBT) will not experience symptom remission. Youth with anxiety and OCD report high rates of sleep problems; evidence suggests that self-reported sleep-related problems predict slower improvement and poorer clinical outcomes in exposure-based CBT. Gaps in knowledge remain about the role of sleep for therapeutic learning during CBT treatment. This project aims to address these gaps by integrating multi-method sleep assessments with fear extinction learnings, which is one of the presumed mechanisms of action in CBT for anxiety and/or OCD. The research objectives are to characterize sleep problems in a sample of youth with anxiety and/or OCD and examine the association between sleep variables and psychophysiological measures of fear extinction learning. The central methodology involves multi-method sleep assessments including self-report measures, actigraphy, and night time electroencephalography, and a computer-based fear extinction learning task, which includes measuring skin conductance responses (SCR) in 84 adolescents (age 13-17) with primary anxiety or OCD entering a CBT-based intensive outpatient program. The central hypothesis is that shorter sleep quantity and greater sleep disruption are associated with psychophysiological responses indicating reduced fear extinction learning and reduced fear extinction recall in adolescents with anxiety and OCD. This project is innovative in that the use of multi-method sleep assessments in a clinical sample of youths with anxiety and/or OCD is novel. In addition, linking sleep measures with psychophysiological indexes of fear extinction learning in a clinical sample of youths has not yet been done, to our knowledge. Future research will investigate these associations with repeated measurement across a full course of CBT treatment. If successful, we will be poised to develop and test augmentation strategies that target specific aspects of sleep that contribute to sub-optimal fear extinction learning. Ultimately, results from this work may serve as proof-of-concept for identifying sleep targets to guide the augmentation of behavioral treatments for anxiety and OCD.