Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety

小儿焦虑症 CBT 结果的维度大脑行为预测因素

• 批准号: 9162830
• 负责人: Kate Dimond Fitzgerald
• 金额: $ 63.53万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-19 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9162830
• 关键词: Acute; Address; Adolescence; Adolescent; Affect; Aftercare; Age; Amygdaloid structure; Anterior; Anxiety; Anxiety Disorders; Attention; Behavior; Behavioral; Brain; Child; Childhood; Chronic; Clinical; Clinical Trials; Cognitive; Cognitive Therapy; Data; Development; Disease; Dorsal; Drops; Educational process of instructing; Face; Fright; Functional Magnetic Resonance Imaging; Goals; Heterogeneity; Impairment; Individual; Individual Differences; Insula of Reil; Intervention; Knowledge; Lead; Life; Measures; Mental Depression; Neurosciences; Patients; Performance; Population; Prefrontal Cortex; Psychopathology; Publishing; Randomized; Randomized Clinical Trials; Regression Analysis; Regulation; Relaxation; Research; Research Domain Criteria; Research Project Grants; Residual state; Scanning; Schools; Science; Severities; Shapes; Staging; Structure; Substance abuse problem; Suicide; Symptoms; Testing; Time; Treatment Efficacy; Treatment outcome; Variant; Work; Youth; active control; anxiety symptoms; anxious; base; brain behavior; childhood anxiety; cingulate cortex; clinically significant; cognitive control; cognitive training; comparison group; cost; desensitization; experience; improved; indexing; neural circuit; neurodevelopment; next generation; older patient; predicting response; prevent; response; therapy outcome; treatment response; white matter

Impairing anxiety affects 33% of the population by adolescence and can become chronic, leading to depression, substance abuse, school-drop out and even suicide. To reduce anxiety and prevent its sequelae, patients must be effectively treated early; yet, the first line intervention, cognitive behavioral therapy (CBT), has a heterogeneous response with 40-60% of treated patients continuing to experience impairment from residual symptoms. The reasons for variability in CBT outcomes remain poorly understood, but individual (including developmental) differences in brain-behavioral targets of CBT may contribute. This proposal addresses two fundamental and open questions: 1) Do individual differences in CBT-relevant brain-behavioral functions lead to variation in CBT outcomes? and 2) Does development contribute to this variation? By defining dimensional constructs at multiple levels of analysis, NIMH's RDoC provides a framework for identifying patient-specific mechanisms of CBT outcomes, across traditional, categorical anxiety disorders. The RDoC constructs of Cognitive Control (CC), Acute Threat (AT) and their interactions (CC-AT) shape the selection of putative brain- behavior targets of CBT for the proposed study. Given that CBT facilitates control over acute threat to enable effective regulation, we hypothesize that AT-, CC- and AT-CC-defined markers will predict and characterize mechanisms of CBT effect. In addition, based on emerging evidence (including our own pilot data) showing later development of neural substrate for cognitive control compared to earlier increase in brain reactivity to threat, we hypothesize that AT, CC, CC-AT markers will differentially relate to CBT effect, depending on patient age. These hypotheses will be tested by measuring data at multiple levels of analysis: brain function-structure (fMRI, DTI) and behavioral performance to index in AT, CC and CC-AT constructs, and clinical measures of anxiety in 280 youths. Of these, 210 youths with impairing anxiety will be randomized to receive CBT or a relaxation control therapy and multilevel data will be collected again after treatment. The project will connect developmental neuroscience and clinical trial research to enable a mechanistic understanding of how different patients at different ages benefit from CBT.

到青春期，33%的人会受到焦虑的影响，并可能变成慢性的，导致