Brain Mechanisms of Cognitive Behavioral Therapy for Social Anxiety Disorder

描述(由申请者提供)：这项以患者为导向的职业发展奖(K23)申请旨在推进候选人的长期职业目标，即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，社交焦虑症是一个主要的公共卫生问题。悲伤的症状包括过度消极的社会评价信念和对与威胁相关的刺激(例如，“严厉”的面孔)的注意偏向。神经成像证据表明，SAD涉及前额叶区域的功能障碍，这些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广泛使用的一线治疗方法；然而，许多认知行为疗法并不能完全康复。CBT的认知部分需要更高阶的功能(例如，重新构建令人恐惧的情况以使其不那么恐惧的能力)。治疗的成功与负面信念和注意偏差的减少/消除有关，尽管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。具体地说，目前还不清楚负面信念和注意力偏差的减少是由于前额叶区域的重叠还是相对不同造成的。拟议的项目包括一项动手的CBT前后功能磁共振成像(FMRI)研究，以阐明SAD恢复的特定神经机制。应聘者将以她在SAD方面强大的CBT背景为基础，并获得以下领域专家的指导：情绪的大脑成像和情绪-认知交互作用(Phan博士，Liberzon)；认知情感神经科学(Phan博士，Abelson，Liberzon)；对SAD和转化性临床试验的注意力和认知调查(Gross博士，Amir)；以及心理治疗结果研究(Himle博士，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。我们将使用忽略严酷面孔的注意任务和重新评估严酷面孔的任务，分别考察CBT对涉及内隐和外显情绪调节的前额叶区域的影响。短期培训目标是：1)神经成像(FMRI)研究方法学和统计学方面的高级培训，2)认知情感神经科学知识的增加，以及3)心理社会治疗临床试验方法论方面的高级培训。影响：社交焦虑症是高度普遍和致残的；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，并有助于推进新的、更精细的疗法，以增加治疗成功的可能性。

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.