Reward System Recovery Following Behavioral Activation Therapy in Depression

描述(申请人提供)：拟议研究的目标是使用功能磁共振成像(FMRI)检查严重抑郁障碍患者抑郁症状减轻的神经相关性。具体地说，我们建议在两个时间点获取严重抑郁障碍患者的功能成像数据，包括在为期8至15周的简短行为激活抑郁症治疗之前和之后，这是一种结构合理且得到充分验证的认知行为治疗方法，旨在降低对损失的敏感性和增强对奖励的敏感性(Hopko等人，2003a)。成像数据将集中于在使用财富之轮任务预期奖励期间，激活包括眼眶前额叶和前额叶皮质、前扣带回，特别是腹侧纹状体的奖励网络(Ernst等人，2004年)。这项先前验证的任务旨在引起对奖励期望的反应，并已被证明激活了这一奖励网络，以响应非临床样本的奖励期望(Ernst等人，2005；Ernst等人，2004)。这个奖赏网络，尤其是腹侧纹状体，对于处理奖赏预期和激励动机的线索是至关重要的(例如，Keedwell等人，2005)。在认知行为疗法后，对奖励预期的反应增加了这个奖励网络中的神经激活，这将与许多领域的症状减少有关，最明显的是快感丧失的症状(即快感丧失)。这项拟议的研究有可能通过确定治疗的哪些组成部分影响对回报的预期来磨练严重抑郁障碍的心理干预目标，而回报预期是这种精神疾病的核心缺陷。这项研究对公众健康的好处将是更好地理解一种特定形式的心理治疗如何治疗抑郁症。确定特定治疗抑郁症有效性的大脑标志物，将使未来的研究能够评估一系列治疗方法，所有这些治疗方法都具有不同的成本和副作用，以确定对患有严重抑郁障碍的个人的最佳治疗方法。这样的策略与NIMH减轻精神障碍负担的使命是一致的。

DESCRIPTION (provided by applicant): The goal of the proposed research is to examine the neural correlates of depressive symptom reduction in individuals with major depressive disorder using functional magnetic resonance imaging (fMRI). Specifically, we propose to acquire functional imaging data from individuals with major depressive disorder at two points in time, both before and after an 8- to 15-week course of Brief Behavioral Activation Treatment for Depression, a structured and well-validated method of cognitive behavioral therapy designed to reduce sensitivity to loss and enhance sensitivity to reward (Hopko et al., 2003a). Imaging data will focus on activation of a reward network comprising the orbitofrontal and prefrontal cortices, the anterior cingulate, and, in particular, the ventral striatum, during anticipation of reward using the Wheel of Fortune Task, (Ernst et al., 2004). This previously validated task was designed to elicit responding to reward expectation and has been shown to activate this reward network in response to reward expectations in nonclinical samples (Ernst et al., 2005; Ernst et al., 2004). This reward network and the ventral striatum in particular, are critical for processing reward anticipation and cues of incentive motivation (e.g., Keedwell et al., 2005). Increased neural activation in this reward network in response to anticipation of reward after cognitive behavioral therapy will be evaluated in relation to symptom reduction in a number of domains, most notably symptoms of loss of pleasure (i.e., anhedonia). The proposed study has the potential to hone the targets of psychological interventions for major depressive disorder by identifying which components of therapy effect the anticipation of rewards, a central deficit in this psychiatric condition. The benefit to public health provided by this study would be a better understanding of how a specific form of psychotherapy may work to treat depression. The identification of brain markers of the effectiveness of a specific treatment for depression would enable future studies to evaluate a range of treatments, all with various costs and side-effect profiles, to determine optimum treatments for individuals suffering from major depressive disorder. Such a strategy is consistent with NIMH's mission to reduce the burden of psychiatric disorders.