Brain Mechanisms of Cognitive Behavioral Therapy for Social Anxiety Disorder

这个指导以患者为导向的职业发展奖（K23）应用程序旨在推进候选人的长期职业目标，成为一名独立的临床科学家，以改善社交焦虑症（SAD）的心理社会治疗，这是一个主要的公共卫生问题。SAD症状包括过度的负面社会评价信念和对威胁相关刺激的注意力偏差（例如，“苛刻”的面孔）。神经影像学证据表明，SAD涉及前额叶区域的功能障碍，该区域与参与威胁处理的边缘区域相互作用。认知行为疗法（CBT）是SAD中广泛使用的一线治疗方法;然而，许多人并没有完全恢复CBT。CBT的认知部分需要高阶功能（例如，重新构建一个令人恐惧的情况，使其不那么可怕的能力）。治疗成功与减少/消除消极信念和注意力偏差有关，即使内隐偏差的修改不是干预的目标。这对于更好地理解CBT的神经机制具有重要意义。具体来说，目前尚不清楚消极信念和注意力偏差的减少是否是由于重叠或相对不同的前额叶区域。拟议的项目包括一个动手前/后CBT功能磁共振成像（fMRI）研究，以阐明特定的神经机制在SAD恢复。候选人将建立在她强大的SAD CBT背景上，并获得情感和情感认知互动脑成像领域专家的指导（Phan，Liberzon博士）;认知情感神经科学（Phan，Abelson，Liberzon博士）; SAD和转化临床试验的注意力和认知探针（Gross，Amir博士）;和心理治疗结果研究（Himle，Rauch博士）。参与者将包括50名全身性SAD患者和25名匹配的健康对照。一个注意任务，忽略苛刻的面孔和重新评价任务，以重新框架苛刻的面孔将被用来检查CBT的影响，涉及内隐和外显情绪调节的前额叶区域，分别。短期培训目标是：1）神经影像学（fMRI）研究方法和统计学的高级培训，2）认知情感神经科学的知识增加，3）心理社会治疗临床试验方法的高级培训。影响：社交焦虑障碍是非常普遍和致残的;更好地了解CBT的大脑机制和治疗反应的个体差异将提高我们对CBT的理解，从而优化当前的干预措施，并有助于新的，更精细的治疗方法的进步，以增加治疗成功的概率。

DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Career Development Award (K23) application is designed to advance the candidate's long-term career goal of becoming an independent clinician scientist to improve psychosocial treatment of social anxiety disorder (SAD), a major public health problem. SAD symptoms include excessive negative social-evaluative beliefs and attentional bias for threat-relevant stimuli (e.g., "harsh" faces). Neuroimaging evidence suggests SAD involves dysfunction in prefrontal regions that interact with limbic regions engaged in threat processing. Cognitive behavioral therapy (CBT) is a widely used first-line treatment in SAD; however, many do not fully recover with CBT. The cognitive component of CBT requires higher-order functions (e.g., ability to reframe a feared situation to make it less fearful). Therapeutic success is associated with reduction/elimination of negative beliefs and attentional bias even though modification of implicit bias is not a target of intervention. This has important implications for better understanding neural mechanisms of CBT. Specifically, it is not clear if reductions in negative beliefs and attentional bias are due to overlapping or relatively distinct prefrontal regions. The proposed project includes a hands-on pre/post-CBT functional magnetic resonance imaging (fMRI) study to elucidate specific neural mechanisms in SAD recovery. The candidate will build on her strong CBT background for SAD and gain mentoring by experts in the fields of brain imaging of emotion and emotion-cognition interactions (Drs. Phan, Liberzon); cognitive affective neuroscience (Drs. Phan, Abelson, Liberzon); attentional and cognitive probes of SAD and translational clinical trials (Drs. Gross, Amir); and psychotherapy outcome research (Drs. Himle, Rauch). Participants will comprise 50 patients with generalized SAD and 25 matched healthy controls. An attentional task to ignore harsh faces and a reappraisal task to reframe harsh faces will be used to examine the effects of CBT on prefrontal regions implicated in implicit and explicit emotion regulation, respectively. Short-term training goals are: 1) advanced training in Neuroimaging (fMRI) Research Methodology and Statistics, 2) increased knowledge in Cognitive Affective Neuroscience, and 3) advanced training in Psychosocial Treatment Clinical Trials Methodology. IMPACT: Social anxiety disorder is highly prevalent and disabling; a better understanding of CBT brain mechanisms and of individual differences in treatment response will improve our understanding of CBT thereby optimizing current interventions and contribute to the advancement of new, more refined therapies to increase the probability of therapeutic success.