Effects of behavioural activation with and without citalopram on emotional cognition and mood

使用和不使用西酞普兰的行为激活对情绪认知和情绪的影响

• 批准号: 2111199
• 金额: --
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2111199
• 关键词: Effects; behavioural; activation; without; citalopram

A body of research literature has shown that patients with depression tend to have a bias towards negative stimuli in their automatic cognitive processes. For example, depression is linked to a relative increase in attention to and memory for negative words and facial expressions (Roiser & Sahakian, 2013) as well as a decrease in the positive bias for ambiguous stimuli that is found in healthy samples (Milders et al., 2010). Rather than just being an epiphenomenon, evidence suggests that these biases might play a causal role by being a risk factor for depression onset (Joormann, Talbot, & Gotlib, 2007) as well as a possible predictor of relapse (Bouhuys, Geerts & Gordijn, 1999).Importantly, positive changes in these automatic biases have been linked to the early phase of antidepressant drug treatment (Harmer et al., 2003). Harmer, Goodwin and Cowen (2009) have proposed a cognitive neuropsychological model of antidepressant drug mechanism whereby early changes in automatic processing of emotional stimuli occur before conscious changes in mood. In line with this, Tranter et al. (2009) found evidence that early changes in the automatic bias for facial expression recognition at two weeks of drug treatment may be predictive of treatment success at six weeks. However, it is not clear why this early change in affective bias does not occur for everyone and many people don't respond to their first line antidepressant treatment.As suggested by Harmer et al. (2017), the early cognitive changes in affective bias induced by drug treatment are expected to interact with positive environmental reinforcement to eventually improve mood. If positive environmental reinforcement is necessary for interacting with the drug-induced positive bias and thus potentiating drug efficacy, this could explain variability in how patients respond to antidepressant drugs. Indeed, several lines of evidence suggest the importance of environmental reinforcement in antidepressant treatment. For instance, Shiroma et al. (2014) found that increase in positive bias after antidepressant administration was greater in patients with higher levels of social support. This is also consistent with evidence from animal research wherein animals in better environments show a better response to antidepressant drugs, as well as higher brain BDNF levels (Branchi et al., 2006). To our knowledge, the interaction between antidepressant effects and environmental reinforcement has not been experimentally tested in humans. The aim of this DPhil is to examine the role of environmental reinforcement on cognitive biases with and without added antidepressant treatment, using behavioural activation (BA). This is a NICE-recommended depression treatment (National Institute of Health and Care Excellence, [NICE], 2009), which aims to increase patients' activity and environmental reward by helping them get back to abandoned activities before they feel motivated for it. This is achieved through a structured programme of activity monitoring, gradual goal setting and coach-like support. The purpose of the first study is to test the early effects of a BA intervention on emotional cognition and mood. We aim to recruit 90 participants and randomise them into either 1) 4 weeks of BA, 2) 4 weeks of activity monitoring (active control group) or 3) passive control group, while collecting data at the beginning, middle and end of the intervention. The second experiment of this DPhil will combine BA with antidepressant drug treatment for 2 weeks to examine the early effects on cognitive biases. We aim to recruit 120 participants experiencing depression and randomise them into four groups (BA with antidepressants, BA with placebo, antidepressants alone and placebo alone). Overall, this should aid our understanding of the onset of early cognitive changes in different depression treatment types.

大量研究文献表明，抑郁症患者在自动认知过程中倾向于对负面刺激产生偏见。例如，抑郁症与对负面词语和面部表情的注意力和记忆力的相对增加有关（Roiser & Sahakian，2013），以及与对健康样本中发现的模糊刺激的正偏差的减少有关（Milders等人，2010年）。证据表明，这些偏差不仅仅是一种附带现象，而是可能通过成为抑郁症发作的风险因素（Joormann，塔尔博特，& Gotlib，2007）以及复发的可能预测因子（Bouhuys，Gebriot & Gordijn，1999）而发挥因果作用。重要的是，这些自动偏差的积极变化与抗抑郁药物治疗的早期阶段有关（Harmer et al.，2003年）。Harmer，Goodwin和Cowen（2009）提出了抗抑郁药物机制的认知神经心理学模型，其中情绪刺激自动处理的早期变化发生在情绪的有意识变化之前。与此一致，Tranter等人（2009）发现证据表明，药物治疗两周时面部表情识别自动偏差的早期变化可能预示着六周后的治疗成功。然而，目前尚不清楚为什么这种情感偏见的早期变化并不发生在每个人身上，许多人对一线抗抑郁药治疗没有反应。正如Harmer et al.（2017）所建议的那样，药物治疗诱导的情感偏见的早期认知变化预计将与积极的环境强化相互作用，最终改善情绪。如果积极的环境强化是必要的相互作用与药物诱导的积极的偏见，从而增强药物的疗效，这可以解释患者如何响应抗抑郁药物的变异性。事实上，一些证据表明环境强化在抗抑郁治疗中的重要性。例如，Shiroma et al.（2014）发现，在社会支持水平较高的患者中，抗抑郁药给药后的正偏倚增加更大。这也与来自动物研究的证据一致，其中在更好的环境中的动物显示出对抗抑郁药物的更好的反应，以及更高的脑BDNF水平（Branchi等人，2006年）。据我们所知，抗抑郁作用和环境强化之间的相互作用尚未在人类身上进行过实验测试。本哲学博士的目的是研究环境强化对认知偏差的作用，使用行为激活（BA），有和没有添加抗抑郁药治疗。这是NICE推荐的抑郁症治疗方法（National Institute of Health and Care Excellence，[NICE]，2009），旨在帮助患者在感到有动力之前重新开始放弃的活动，从而增加患者的活动量和环境回报。这是通过活动监测、逐步设定目标和教练式支持的结构化计划来实现的。第一项研究的目的是测试BA干预对情绪认知和情绪的早期影响。我们的目标是招募90名参与者，并将他们随机分为1）4周的BA，2）4周的活动监测（主动控制组）或3）被动控制组，同时在干预开始，中间和结束时收集数据。本DPhil的第二个实验将联合收割机BA与抗抑郁药物治疗相结合，持续2周，以检查对认知偏差的早期影响。我们的目标是招募120名患有抑郁症的参与者，并将他们随机分为四组（BA与抗抑郁药，BA与安慰剂，单独抗抑郁药和单独安慰剂）。总的来说，这有助于我们理解不同抑郁症治疗类型的早期认知变化。