Brain Mechanisms of Cognitive Behavioral Therapy for Social Anxiety Disorder

社交焦虑症认知行为治疗的脑机制

• 批准号: 8642207
• 负责人: Heide Klumpp
• 金额: $ 18.96万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-15 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8642207
• 关键词: Adult; Affect; Aftercare; Amygdaloid structure; Anterior; Anxiety; Anxiety Disorders; Attention; Attenuated; Behavior; Behavioral; Belief; Biological Markers; Brain; Brain imaging; Brain region; Clinical Trials; Cognition; Cognitive; Cognitive Science; Cognitive Therapy; Data; Disease; Distress; Dorsal; Educational process of instructing; Emotional; Emotions; Exhibits; Face; Failure; Fright; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Impaired cognition; Individual; Individual Differences; Intervention; K-Series Research Career Programs; Knowledge; Link; Literature; Medial; Mediating; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Modification; Outcome; Outcomes Research; Participant; Patients; Perception; Physiological; Prefrontal Cortex; Probability; Process; Psychotherapy; Public Health; Recommendation; Recovery; Regulation; Research; Research Methodology; Resources; Sample Size; Scientist; Signal Transduction; Stimulus; Sweat; Sweating; Symptoms; Testing; Therapeutic; Therapeutic Effect; Therapy Clinical Trials; Training; affective neuroscience; base; behavior measurement; career; cingulate cortex; cognitive enhancement; cognitive function; design; emotion regulation; improved; indexing; neuroimaging; neuromechanism; patient oriented; psychologic; psychosocial; relating to nervous system; skills; social; social model; statistics; success; translational clinical trial; treatment response

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.

描述（由申请人提供）：此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）这一主要公共卫生问题的心理社会治疗。 SAD 症状包括过度消极的社会评价信念和对威胁相关刺激的注意力偏差（例如“严厉”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) 是广泛用于 SAD 的一线治疗方法；然而，许多人并没有通过 CBT 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）。尽管改变内隐偏见不是干预的目标，但治疗的成功与消极信念和注意力偏见的减少/消除有关。这对于更好地理解 CBT 的神经机制具有重要意义。具体来说，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造成的。拟议的项目包括一项 CBT 前/后功能磁共振成像 (fMRI) 实践研究，以阐明 SAD 恢复中的特定神经机制。候选人将以其强大的 SAD 认知行为治疗背景为基础，并获得情绪脑成像和情绪认知相互作用领域专家的指导（Liberzon Phan 博士）；认知情感神经科学（Drs. Phan、Abelson、Liberzon）； SAD 的注意力和认知探索以及转化临床试验（Drs. Gross、Amir）；和心理治疗结果研究（Himle、Rauch 博士）。参与者将包括 50 名患有广泛性 SAD 的患者和 25 名匹配的健康对照者。忽略严酷面孔的注意力任务和重新构建严酷面孔的重新评估任务将分别用于检查 CBT 对与内隐和外显情绪调节有关的前额叶区域的影响。短期培训目标是：1) 神经影像 (fMRI) 研究方法和统计学高级培训，2) 增加认知情感神经科学知识，3) 心理社会治疗临床试验方法学高级培训。影响：社交焦虑症非常普遍，并且会造成残疾；更好地了解 CBT 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，并有助于开发新的、更精细的疗法，以提高治疗成功的可能性。