MICA: The Translational, Computational and Neurocognitive Basis of Anxiety

我们四分之一的人在特定的一年里会遭受某种形式的心理健康问题。对于我们大多数人来说，这将是某种形式的焦虑或压力相关的问题。有些人的焦虑是如此严重，以至于他们最终被困在家里。焦虑每年给英国经济造成的损失超过140亿英镑。我们目前有有效的临床治疗方法，包括心理治疗（即治疗）和药物治疗（即药物治疗），可以治疗焦虑。然而，我们目前还不能有效地将这些治疗针对那些有反应的人。事实上，对于大多数人来说，他们尝试的第一次治疗不会奏效。更令人担忧的是，对于高达25%的患者，我们目前的治疗方法都不起作用。我们有这些针对性治疗的问题至少有两个原因：I）我们不知道我们目前的治疗方法在生物学水平上是如何工作的II）我们不知道焦虑的衰弱感是如何从潜在的生物学中产生的。如果没有更好地理解这两个问题，我们就不会提高我们针对性治疗的能力。因此，该奖学金旨在提高我们对焦虑症状和治疗的生物学基础的理解。它侧重于心理治疗，旨在更好地了解1）心理治疗工作的神经回路; 2）开发新的心理治疗方法; 3）更好地完善我们对焦虑诊断的生物学基础的理解。具体来说：1）神经回路：在过去的十年里，我已经确定了一个驱动焦虑感的大脑回路，但我们不知道它是否会在治疗后发生变化。在这个项目中，我将扫描接受焦虑心理治疗的焦虑者的大脑，并将他们与没有接受心理治疗的焦虑者进行比较。如果我们证明同样的回路对治疗反应很重要，它将使我们能够更好地针对个人进行治疗，并减少尝试对他们无效的治疗的人数。2）治疗：与此同时，我将尝试开发一种新的计算机化焦虑治疗方法。这是可能的，因为我在一个新领域的进展被称为计算精神病学给了我们工具，提供了更好的洞察大脑的计算过程，以及它们如何在焦虑症中变化。因此，我将开发一种针对这些计算过程的计算机化训练程序，并在治疗研究中进行测试。如果这是可行的，它将提供一种快速和具有成本效益的治疗，可以通过智能手机提供，并最终减少患焦虑症的人数。3）诊断：最后，我将试图提高我们对焦虑感如何出现的理解。越来越清楚的是，我们目前的诊断，这是基于症状检查表，并没有反映真正独立的生物类别。因此，我将寻找“跨诊断”维度，这些维度驱动焦虑，但却跨越了我们目前的类别。我将通过让成千上万的人在网上完成一项简单的心理任务来做到这一点，我以前曾将其与使人衰弱的焦虑联系起来。此外，我们还将从这些人那里收集广泛的其他心理任务和问卷。将最先进的统计方法应用于这些“大数据”将使我们能够识别驱动焦虑症状的跨诊断维度。从长远来看，这些新的跨诊断维度将提高我们确定驱动症状的生物因素的能力，从而帮助我们预测治疗反应并开发新的治疗方法。总之，我将联合收割机我独特的跨学科技能，以及我在描绘焦虑的神经和计算基础方面的突破，为焦虑的诊断和治疗开发新的更有效的临床工具，最终目标是改善数百万患者的生活质量。

One in four of us will suffer from some form of mental health problem in a given year. For the majority of us, this will be some form of anxiety or stress related problem. Some people's anxiety is so crippling that they end up housebound. Anxiety costs the UK economy over £14 billion a year.We currently have effective clinical treatments, both psychological (i.e. therapy) and pharmacological (i.e. medication), that can treat anxiety. However, we are not currently able to effectively target these treatments to people who will respond. In fact, for most people, the first treatment that they try will not work. Even more worrying is that for up to 25% of sufferers; none of our current treatments will work.There are at least two reasons that we have these problems targeting treatments:I) We do not know how our current treatments work at a biological levelII) We do not know how debilitating feelings of anxiety emerge from the underlying biology.Without a better understanding of both of these issues we will not improve our ability to target treatments. This fellowship therefore seeks to improve our understanding of the biological basis of anxiety symptoms and treatments. It focuses on psychological treatments and aims to better understand 1) the neural circuitry by which psychological treatment works; 2) develop new psychological treatments; and 3) better refine our understanding of the biological bases of anxiety diagnosis. Specifically:1) Neural Circuitry:Over the last decade, I have identified a brain circuit which drives feelings of anxiety but we do not know if it changes following treatment. In this project I will scan the brains of anxious people undergoing psychological treatment for anxiety and compare them to anxious people who are not. If we show that this same circuit is important for treatment response, it will enable us to better target treatments to individuals, and reduce the number of people who try treatments that do not work for them.2) Treatments:In parallel with this I will attempt to develop a new computerised treatment for anxiety. This is possible because my advances in a new field known as computational psychiatry have given us tools that provide better insight into the computational process of the brain, and how they change in anxiety disorders. I will therefore develop a computerised training procedure that targets these computational processes and test it in a treatment study. If this works, it will provide a quick and cost effective treatment that could be delivered by smartphones and ultimately reduce the number of individuals suffering from anxiety.3) Diagnosis:Finally, I will try to improve our understanding of how debilitating feelings of anxiety emerge in the first place. It is increasingly clear that our current diagnoses, which are based on symptom checklists, do not reflect truly separate biological categories. I will therefore search for 'trans-diagnostic' dimensions that drive anxiety but which cut across our current categories. I shall do this by getting thousands of people to complete a simple psychological task online that I have previously linked to debilitating anxiety. In addition, we will collect a wide range of other psychological tasks and questionnaires from these people. Applying state-of-the-art statistical methods to this 'big data' will enable us to identify trans-diagnostic dimensions that drive anxiety symptoms. In the long term these new trans-diagnostic dimensions will improve our ability to determine the biological factors driving symptoms and hence help us predict treatment response and develop new treatments.In sum, I will combine my unique inter-disciplinary skill-set, with my breakthroughs in delineating the neural and computational basis of anxiety, to develop new and more effective clinical tools for anxiety diagnosis and treatment, with the ultimate goal of improving the quality of life for millions of sufferers.