Attention Bias Modification for Anxiety: A Randomized Control Trial with Biomarke

焦虑的注意力偏差修正：Biomarke 的随机对照试验

• 批准号: 8630290
• 负责人: TRACY A DENNIS
• 金额: $ 34.69万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8630290
• 关键词: Address; Adult; Affect; Anxiety; Anxiety Disorders; Attention; Behavior; Behavioral; Biological; Biological Markers; Clinical; Cognitive; Cognitive Therapy; Computers; Development; Dimensions; Disease; Disease remission; Etiology; Evaluation; Event-Related Potentials; Exhibits; Functional Magnetic Resonance Imaging; Functional disorder; Galvanic Skin Response; Goals; Heart Rate; Individual; Individual Differences; Intervention; Intervention Studies; Knowledge; Maintenance; Measures; Mental disorders; Meta-Analysis; Modification; National Institute of Mental Health; Neurocognitive; Participant; Placebo Control; Placebos; Process; Psychiatric Diagnosis; Randomized; Randomized Controlled Trials; Reaction Time; Research; Resolution; Scalp structure; Selective Serotonin Reuptake Inhibitor; Severities; Societies; Staging; Stimulus; Strategic Planning; Stress; Symptoms; Testing; Training; Treatment Efficacy; United States National Institutes of Health; base; common treatment; cost; cost effective; economic cost; effective intervention; follow-up; innovation; intervention effect; millisecond; novel; public health relevance; relating to nervous system; remediation; response; social; stressor; treatment effect; treatment response

DESCRIPTION (provided by applicant): Anxiety disorders are the most common psychiatric diagnosis, affecting as many as 29% of people during their lifetime. In addition to the devastating personal cost of anxiety, the yearly economic cost to society has been estimated to be around 46.6 billion. Major progress has been made in the treatment of anxiety using selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT). However, obstacles to their wide-scale use and high remission rates (about 50%) suggest the need for complementary treatment approaches. Computer-based attention bias modification (ABM) treatment, which is brief, cost-effective, and easy to administer, addresses common treatment barriers and targets a key mechanism in pathological anxiety - the threat bias, or exaggerated attention towards threatening stimuli. ABM uses a modified version of the dot probe task to train anxious individuals to redirect attention away from threat. A recent meta-analysis of ABM effects on anxiety documents reductions in anxiety symptom severity, with effect sizes comparable to those for CBT. However, no research has evaluated specific neurocognitive mechanisms underlying ABM's effects on anxiety, nor attempted to identify biomarkers that can predict treatment response. The goal of the proposed project is to conduct the first large-scale RCT of ABM treatment for anxiety that integrates a neural biomarker approach to elucidate neurocognitive mechanisms underlying treatment efficacy and to test whether these biomarkers can identify those individuals for whom remediation of attention dysfunction via ABM will be most effective. Scalp-recorded event- related-potentials will be the biomarker due to their extremely high temporal resolution and sensitivity to automatic and controlled attentional processes that are implicated in ABM. The proposed research will pursue two Specific Aims: Aim 1 will test whether ABM treatment modifies ERP responses to threat in 90 anxious adults. We predict that adults who receive ABM (versus placebo) will exhibit at post-training: (a) significantly larger ERPs indicating increased control of attention to threat (N2/N2pc/P3); and (b) significantly reduced ERPs indicating diminished facilitated attention to threat (P1, P2) - although previous mixed evidence suggests these effects may be less robust than those for controlled attention. We will test the exploratory hypothesis that these changes in ERPs due to ABM will predict reductions in reaction-time based measures of threat bias. Aim 2 will test whether changes in ERPS due to ABM (detailed in Aim 1) are associated with reduced anxiety severity. We predict that changes in ERPs reflecting increased control of attention, and to a lesser degree reduced facilitation of attention to threat will predict amelioration of anxiety and stress reactivity following treatment. We will examine maintenance of treatment effects four months following treatment completion. We will also assess whether ERPS can be used to predict treatment response by testing the exploratory hypothesis that participants showing ERP responses at baseline indicating greater biased attention to threat (greater facilitation (larger P1/P2) and reduced control of attention (diminished N2/N2pc/P3)) will benefit most from remediation of attention dysfunction and thus show greatest reductions in anxiety severity and stress reactivity due to ABM. The proposed research, by integrating neural and behavioral markers, represents a crucial next step in understanding mechanisms underlying plasticity of the threat bias and remediation of anxiety. Such findings have the potential to yield high impact knowledge of the etiology of anxiety disorders, create more targeted, personalized, and cost-effective interventions for anxiety, and help predict individual differences in treatment response.

描述（由申请人提供）：焦虑症是最常见的精神病诊断，影响多达29%的人在他们的一生。除了焦虑造成的毁灭性的个人损失外，每年对社会造成的经济损失估计约为466亿美元。使用选择性5-羟色胺再摄取抑制剂（SSRIs）和认知行为疗法（CBT）治疗焦虑症已取得重大进展。然而，其大规模使用的障碍和高缓解率（约50%）表明需要补充治疗方法。基于计算机的注意力偏差修正（ABM）治疗，这是简短的，具有成本效益，易于管理，解决了常见的治疗障碍，并针对病理性焦虑的关键机制-威胁偏见，或对威胁性刺激的夸大注意力。ABM使用点探测任务的修改版本来训练焦虑的个体将注意力从威胁转移开。最近的一项关于ABM对焦虑影响的荟萃分析记录了焦虑症状严重程度的降低，其效果大小与CBT相当。然而，没有研究评估ABM对焦虑影响的具体神经认知机制，也没有试图确定可以预测治疗反应的生物标志物。拟议项目的目标是进行第一个大规模的随机对照试验的ABM治疗焦虑，整合了神经生物标志物的方法，以阐明神经认知机制的治疗效果，并测试这些生物标志物是否可以识别那些人的注意力功能障碍的补救通过ABM将是最有效的。头皮记录的事件相关电位将是生物标志物，因为它们具有极高的时间分辨率和对ABM中涉及的自动和受控注意过程的敏感性。这项研究将追求两个具体目标：目标1将测试ABM治疗是否会改变90名焦虑成年人对威胁的ERP反应。我们预测，接受ABM（与安慰剂相比）的成年人在训练后将表现出：（a）显著更大的ERP，表明对威胁的注意力控制增加（N2/N2 pc/P3）;（B）显著降低的ERP，表明对威胁的促进注意力减少（P1，P2）-尽管先前的混合证据表明这些效果可能不如控制注意力的效果。我们将检验探索性假设，即ABM引起的ERP的这些变化将预测基于反应时间的威胁偏差测量的减少。目标2将测试ABM引起的ERPS变化（详见目标1）是否与焦虑严重程度降低相关。我们预测，反应注意力控制能力增强的ERP变化，以及较小程度的注意力对威胁的促进作用降低，将预测焦虑的改善 以及处理后的应激反应。我们将在治疗完成后4个月检查治疗效果的维持情况。我们还将评估ERPS是否可以用于预测治疗反应，通过测试探索性假设，即参与者在基线时显示ERP反应表明对威胁的更大偏见（更大的促进作用（更大的P1/P2）和减少对注意力的控制（N2/N2 pc/P3减少））将从注意力功能障碍的补救中受益最多，因此由于ABM而显示出焦虑严重性和应激反应性的最大降低。通过整合神经和行为标记，拟议的研究代表了理解威胁偏见可塑性和焦虑补救机制的关键下一步。这些发现有可能产生高影响的焦虑症病因学知识，创造更具针对性，个性化和成本效益的焦虑干预措施，并帮助预测治疗反应的个体差异。