Targeting Attentional and Cognitive Control to Enhance the Transdiagnostic Treatment of Repetitive Negative Thinking

以注意力和认知控制为目标，加强重复性消极思维的跨诊断治疗

• 批准号: 9976739
• 负责人: Ryan Jane Jacoby
• 金额: $ 18.5万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9976739
• 关键词: Address; Affective; Aftercare; Anxiety; Area; Attention; Behavioral; Clinical; Clinical Trials; Cognitive; Cognitive Therapy; Conflict (Psychology); Control Groups; Cues; Data; Data Reporting; Development Plans; Disease; Dose; Electrophysiology (science); Emotional; Etiology; Event-Related Potentials; Exposure to; Failure; Fright; Funding; Generalized Anxiety Disorder; Goals; Health Care Costs; Impairment; Individual; Intervention; Investigational Therapies; Learning; Maintenance; Major Depressive Disorder; Measurement; Measures; Mediation; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Methods; Monitor; Mood Disorders; National Institute of Mental Health; Nature; Obsessive-Compulsive Disorder; Outcome; P300 Event-Related Potentials; Patient Self-Report; Patients; Positioning Attribute; Process; Protocols documentation; Psyche structure; Psychopathology; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Reaction Time; Refractory; Regulation; Research; Research Domain Criteria; Residual state; Rest; Risk; Ritual compulsion; Science; Scientist; Severities; Specificity; Symptoms; System; Testing; Theoretical model; Therapeutic; Thinking; Training; Treatment Efficacy; Treatment outcome; Uncertainty; Validation; affective neuroscience; associated symptom; attentional control; base; biobehavior; biobehavioral measurement; career development; cognitive control; cognitive process; comorbidity; cue reactivity; depressive symptoms; emotion regulation; emotional stimulus; flexibility; follow-up; functional disability; improved; indexing; individual response; overtreatment; psychologic; relating to nervous system; response; sample fixation; skills; source localization; statistics; stressor; sustained attention; temporal measurement; treatment optimization; treatment response; visual tracking

Although cognitive behavioral therapy (CBT) is an efficacious first-line intervention for individuals with affective disorders, non-responder rates remain high. Repetitive negative thinking (RNT; i.e., mental rituals, worries, depressive ruminations) predicts poor treatment outcome and is a common residual symptom following CBT. Thus, there is an urgent unmet need to identify the mechanistic targets underlying RNT to optimize treatment response and reduce the psychiatric burden and healthcare costs for patients with affective disorders. Given that a hallmark feature of RNT is the difficulty controlling and disengaging from perseverative thought, recent theoretical models propose that deficits in attentional and cognitive control underlie RNT as fundamental biobehavioral targets. Yet studies validating these targets are lacking. This five-year Mentored Patient-Oriented Research Career Development Award will address this need. Specifically, this project will test the hypothesis that enhancing attention regulation skills in a transdiagnostic intervention streamlined and adapted for RNT – Emotion Regulation Therapy-Attention Regulation (ERT-AR) – will significantly improve the proposed target of attentional/cognitive control relative to a supportive psychotherapy (SPT) control group as measured by multi- method target indices: (a) behavioral (i.e., disengagement and sustained attention in the presence of emotional stimuli measured by eye tracking fixations and reaction time), (b) electrophysiological (i.e., proactive and reactive cue- and target-locked N2, N450, and P300 event related potentials in a cued conflict monitoring task), and (c) self-report (i.e., perceived ability to shift and focus attention). We also will examine early signs of treatment efficacy, predicting that ERT-AR will improve RNT and psychiatric functioning outcomes (symptom severity, functional impairment) relative to SPT, and target validation (i.e., changes in attentional/cognitive control will correlate with changes in RNT and associated symptoms). Study aims correspond to specific training goals for the candidate (Dr. Ryan Jacoby) in four key areas that will launch her as an independent translational clinical scientist: (1) affective neuroscience and measurement of biobehavioral targets, (2) clinical trials and experimental therapeutics methodology, (4) advanced longitudinal statistics, and (5) career development. Training goals will be implemented with the expert guidance of Dr. Sabine Wilhelm (primary mentor), co-mentors Drs. Diego Pizzagalli and Douglas Mennin, and advisors Drs. Dan Dillon, Rudi De Raedt, and David Schoenfeld. At baseline, we will assess clinical symptoms and administer well-validated attentional and cognitive control paradigms. Patients with RNT will then be provided 8 sessions of ERT-AR or SPT and will be re-administered assessments at weeks 4 and 8. We will examine changes in our target indices during treatment, as well as changes in outcomes over treatment and 3-month follow-up. If our hypotheses are supported, we will identify a cross-cutting target that can be engaged to optimize treatment response for individuals with elevated RNT, enhancing the generalizability of our findings for maximum public health impact.

虽然认知行为疗法（CBT）是一种有效的第一线干预个体的情感