NEURAL SUBSTRATES OF COGNITIVE-BEHAVIORAL THERAPY FOR SOCIAL ANXIETY DISORDER

该子项目是利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得主要资金， 因此可以在其他CRISP条目中表示。列出的机构是 中心，不一定是研究者的机构。 介绍 本研究旨在探讨认知行为疗法对诊断为社交焦虑障碍的成人的情绪反应和调节的神经基础的影响。 具体目标 该建议的总体目标是阐明社交恐惧症（SP）的情绪反应和认知调节的神经基础，并确定与认知行为治疗（CBT）相关的治疗变化的神经机制。基础研究已经检查了健康对照组（HC）的情绪反应和认知调节[10，11]，但这项研究尚未描述SP患者情绪调节的潜在机制。临床研究表明，CBT是许多SP患者的有效治疗[12]，但尚未很好地描述变化机制和治疗反应的预测因子。为了整合基础和临床文献，我们使用了一个翻译框架，认为情绪调节腹侧情绪生成脑区和背侧情绪调节脑区之间的相互作用。在这个框架内，我们建议检查HC和CBT前后患有广义SP的参与者的情绪反应和认知调节的神经基质。我们提出的研究有3个目的：目的1检查SP与HC的情绪反应和认知调节的神经基质;目的2通过检查SP参与者在CBT之前和之后确定变化机制;目的3评估对CBT的长期治疗反应的预测因素。 该转化研究计划的广泛，长期目标是促进理论和临床干预措施的进步，以改善SP患者的心理健康。 方法和材料 我们打算评估120名成年人（年龄21-55岁）。其中，80人将符合DSM-IV [83]标准，在时间1时初步诊断为当前广泛性社交恐惧症（SP）。其他40名参与者将是非精神病健康对照（HC），每个参与者在年龄、性别、教育、种族和利手方面与SP匹配。 该样本量将提供足够的统计把握度，以检查（a）CBT前时间点1的SP与HC（目标1），（B）通过受试者内和受试者间效应的CBT前后变化（目标2），以及（c）CBT治疗的长期应答预测因子（目标3）。 所有参与者都将接受诊断性访谈、行为评估、一系列问卷调查、计算机任务和功能磁共振成像任务，以评估焦虑、情绪反应和调节的各个方面。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Introduction This study is examining the effect of cognitive-behavioral therapy on the neural bases of emotional reactivity and regulation in adults diagnosed with social anxiety disorder. Specific Aims The overall goal of this proposal is to elucidate the neural bases of emotional reactivity and cognitive regulation in social phobia (SP), and to identify the neural mechanisms underlying therapeutic change associated with cognitive-behavioral therapy (CBT). Basic research has examined emotional reactivity and cognitive regulation in healthy controls (HC) [10, 11], but this research has not yet delineated the mechanisms underlying emotion regulation in individuals with SP. Clinical research has shown that CBT is an effective treatment for many individuals with SP [12], but mechanisms of change and predictors of therapeutic response have not yet been well described. To integrate basic and clinical literatures, we use a translational framework that views emotion regulation in terms of interactions between ventral emotion-generative brain regions and dorsal emotion-regulatory brain regions. Within this framework, we propose to examine the neural substrates of emotional reactivity and cognitive regulation in HC and in participants with generalized SP pre- and post-CBT. Our proposed studies address 3 aims: Aim 1 examines the neural substrates of emotional reactivity and cognitive regulation in SP versus HC; Aim 2 identifies mechanisms of change by examining SP participants pre- and post-CBT; Aim 3 assesses predictors of longer-term treatment responses to CBT. The broad, long-term objective of this translational research program is to contribute to advances in theory and clinical interventions that will improve the psychological health of individuals suffering from SP. Methods and Materials We intend to assess 120 adults (ages 21-55 years). Of these, 80 will meet DSM-IV [83] criteria for a primary diagnosis of current generalized social phobia (SP) at Time 1. The other 40 participants will be non-psychiatric healthy controls (HC) each matched to an SP on age, sex, education, ethnicity, and handedness. This sample size will provide sufficient statistical power to examine (a) SP vs. HC at pre-CBT Time 1 (Aim 1), (b) pre- to post-CBT changes via within- and between-subjects effects (Aim 2), and (c) predictors of longer-term response to CBT treatment (Aim 3). All participants will undergo diagnostic interviewing, behavioral assessment, a battery of questionnaires, computer task, and fMRI task to assess facets of anxiety, emotional reactivity and regulation.