Using CBT to examine circuitry of frustrative non-reward in aggressive children

使用 CBT 检查攻击性儿童的沮丧无奖励回路

• 批准号: 8701416
• 负责人: Kevin A Pelphrey
• 金额: $ 41.63万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8701416
• 关键词: Address; Aftercare; Age; Aggressive behavior; Amygdaloid structure; Anterior; Area; Arousal; Behavior Therapy; Behavioral; Biological Markers; Blinded; Brain; Categories; Child; Classification Scheme; Clinical; Clinical effectiveness; Cognitive Therapy; Coupled; Cues; Data; Diagnostic; Disease; Distress; Dorsal; Educational process of instructing; Electroencephalography; Emotional; Emotions; Evaluation; Event-Related Potentials; Face; Feedback; Frustration; Functional Magnetic Resonance Imaging; Investigation; Learning; Measurement; Measures; Modeling; National Institute of Mental Health; Neurobiology; Neurosciences; Outcome; Outcome Measure; Parents; Perception; Prefrontal Cortex; Prevention; Problem Solving; Psychotherapy; Randomized; Randomized Controlled Trials; Reaction; Research Domain Criteria; Research Priority; Rewards; Scanning; Signal Transduction; Source; Strategic Planning; Stream; Testing; Treatment outcome; Withdrawal; Work; activity marker; base; blood oxygen level dependent; brain behavior; callous unemotional trait; cingulate cortex; cognitive control; emotion regulation; face perception; impression; improved; indexing; interest; neural circuit; neuroimaging; neuromechanism; public health relevance; relating to nervous system; response; skills

DESCRIPTION (provided by applicant): Frustrative non-reward is defined by reactions elicited in response to withdrawal or prevention of reward, most notably reactive aggression. The neural mechanisms of reactive aggression involve heightened amygdala arousal in response to frustration coupled with hypoactivity of prefrontal regions that subserve emotion regulation. This is a proposal for a randomized controlled trial of cognitive-behavioral therapy (CBT) in children with high levels of aggression aimed at explicating the brain-behavior relationship of the frustrative non-reward construct. Because CBT teaches emotion regulation skills, the first objective of the study is to examine whether positive response to CBT for aggression will be associated with decreased activity in the amygdala, the brain area associated with emotional arousal, and increased activity in the brain areas associated with cognitive control of emotion, including the dorsal anterior cingulate cortex and ventromedial prefrontal cortex. Demonstrating that a change in the key nodes of the emotion regulation circuitry is associated with a reduction of reactive aggression will provide evidence to support the validity of the frustrative non-reward construct. The second objective is to explore the moderating effects of the biomarkers of impaired socioemotional perception and reward sensitivity in aggressive children with callous-unemotional traits on response to CBT. Eighty children with high levels of aggression across multiple traditional diagnostic categories, ages 8 to 16, will be randomly assigned to receive 12 sessions of CBT or 12 sessions of Supportive Psychotherapy. Clinical outcomes will be measured by the parent-ratings of aggressive behavior collected at baseline, midpoint and endpoint evaluations and the Improvement Score of the Clinical Global Impression Scale assigned by an independent evaluator (blinded rater). Children will also perform a frustration-induction Go-NoGo task and a task of emotional face perception during fMRI scanning and EEG recording at baseline and endpoint. The frustration-induction Go-NoGo task involves viewing a stream of objects and pressing the button in response to pre-determined experimental conditions. During a portion of the task, frustration is induced by loss of points that can be exchanged for a reward. This task has been shown to engage the neural circuitry of emotion regulation in an earlier fMRI study. The main contrasts of interest for the BOLD signal will be the difference between: (1) neutral versus frustration blocks of the Go-NoGo task, (2) neutral versus emotional faces, and (3) correct versus incorrect Go trials of the Go-NoGo. The main variables of interest for the evoked-related potentials will be: (1) the N2 component to the NoGo trials, (2) P3 component to correct and Feedback-Related Negativity to the incorrect Go trials, and (3) N170 and N250 ERPs to the face perception task. Consistent with the NIMH Strategic Research Priorities, if functional neuroimaging and electrophysiological variables can identify children who respond to cognitive-behavioral therapy for aggression, this can provide a neuroscience- based classification scheme that will improve treatment outcomes for children with aggressive behavior.

描述（由申请人提供）：挫败性无奖励是指因撤回或阻止奖励而引发的反应，最明显的是反应性攻击。反应性攻击的神经机制涉及杏仁核对挫折的反应增强，以及有助于情绪调节的前额叶区域的活动减退。这是一项针对具有高攻击性的儿童进行认知行为治疗（CBT）的随机对照试验的提案，旨在解释沮丧性非奖励结构的大脑与行为关系。由于 CBT 教授情绪调节技能，因此该研究的首要目标是检查对 CBT 攻击性的积极反应是否与杏仁核（与情绪唤醒相关的大脑区域）活动减少以及与情绪认知控制相关的大脑区域（包括背侧前扣带皮层和腹内侧前额叶皮层）活动增加有关。 证明情绪调节回路关键节点的变化与反应性攻击的减少相关，将为支持沮丧性非奖励结构的有效性提供证据。第二个目标是探索具有冷酷无情特征的攻击性儿童的社会情绪感知和奖励敏感性受损的生物标志物对 CBT 反应的调节作用。 80 名年龄在 8 至 16 岁之间、在多个传统诊断类别中具有高攻击性的儿童将被随机分配接受 12 次 CBT 或 12 次支持性心理治疗。临床结果将通过在基线、中点和终点评估时收集的家长对攻击行为的评分以及独立评估者（盲法评估者）指定的临床总体印象量表的改进分数来衡量。孩子们还将在基线和终点的功能磁共振成像扫描和脑电图记录期间执行挫败诱导的 Go-NoGo 任务以及情绪面部感知任务。挫折诱导的 Go-NoGo 任务包括观察一系列物体并按下按钮以响应预先确定的实验条件。在任务的一部分期间，由于可以兑换奖励的积分的丢失而引起挫败感。在早期的功能磁共振成像研究中，这项任务已被证明可以参与情绪调节的神经回路。 BOLD 信号的主要对比是 之间的区别：(1) Go-NoGo 任务的中性与挫败性块，(2) 中性与情绪面，以及 (3) Go-NoGo 的正确与不正确的围棋试验。诱发相关电位感兴趣的主要变量是：(1) NoGo 试验的 N2 部分，(2) P3 组件用于纠正错误的 Go 试验的反馈相关消极性，以及 (3) N170 和 N250 ERP 用于面部感知任务。与 NIMH 战略研究优先事项一致，如果功能性神经影像学和电生理学变量可以识别患有以下疾病的儿童： 应对攻击行为的认知行为疗法，这可以提供基于神经科学的分类方案，从而改善有攻击行为的儿童的治疗结果。