2/2 Harnessing Hormonal Variation to Probe Neural Mechanisms and Optimize CBT Outcomes for OCD
2/2 利用荷尔蒙变化来探索神经机制并优化强迫症的 CBT 结果
基本信息
- 批准号:10651824
- 负责人:
- 金额:$ 68.17万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-09-01 至 2026-06-30
- 项目状态:未结题
- 来源:
- 关键词:AccelerationAdultAffectAftercareAmygdaloid structureAnteriorAnxietyBiologicalBiological AssayBloodBrainBrain regionClinicalCognitive TherapyDataDorsalElementsEnsureEstrogensExhibitsExposure toExtinctionFrightFunctional Magnetic Resonance ImagingGoalsGonadal HormonesHippocampusHormonalHormonesHumanImageIndividualKnowledgeLeadLearningLuteal PhaseManualsMeasuresMediatingMenstrual cycleMenstruationNeuronsNew YorkObsessive-Compulsive DisorderOutcomeParticipantPatientsPennsylvaniaPhasePrefrontal CortexPreventionPrevention ProtocolsProcessProtocols documentationRandomizedRecommendationResearchRestRitual compulsionRodentSample SizeSamplingScanningSeveritiesSex DifferencesSignal TransductionSiteStructureSymptomsTestingTimeTreatment ProtocolsTreatment outcomeUniversitiesVariantWomanblood oxygen level dependentcingulate cortexconditioned feardesignfollow-upfunctional MRI scanimprovedindexinglearning extinctionmemory retentionmenneuralneuromechanismoutcome predictionpersonalized medicinepredicting responseproliferative phase Menstrual cyclerecruitreduce symptomsresponsesevere mental illnesssexsex cycletool
项目摘要
Cognitive behavioral therapy involving exposure and ritual prevention (EX/RP) is a first-line treatment for
obsessive compulsive disorder (OCD). Despite its efficacy, it remains unclear how EX/RP influences the neural
mechanisms of the fear and anxiety brain networks to yield clinical improvement. Moreover, data indicate that
EX/RP outcomes may be more variable in women. Studies in rodents and healthy humans show that estrogen
(E) affects the brain regions involved in fear learning, extinction, and extinction retention (the fear extinction
network); E also has been shown to enhance extinction memory retention. In addition, the structure and
connectivity of these same brain regions predict OCD treatment outcomes, including EX/RP. These and other
data lead to the hypothesis that this Collaborative R01 will begin to test: that delivering EX/RP to women with
OCD during high E states improves extinction memory retention via enhanced engagement of the fear
extinction brain network, resulting in better clinical outcomes. We will also explore whether EX/RP-induced
extinction processes differ between women and men. Our specific aims are to examine: 1) the impact of
menstrual-cycle phase and sex on extinction-induced neural responses pre and post EX/RP; 2) the impact of
menstrual-cycle phase and sex on EX/RP outcome; and 3) the relationship between OCD symptom change
and EX/RP-induced neuronal changes. Our long-term goal is to understand how sex as a biological variable
affects specific neural processes and hence EX/RP treatment outcomes. To achieve our aims, 120 adults with
OCD – 80 natural cycling women and 40 men--will be recruited across two sites: The University of
Pennsylvania (UPenn) and the New York State Psychiatric Institute/Columbia University (NYSPI). Through a
subcontract, New York University (NYU) will provide expertise in the fMRI imaging paradigm that will be used
as an experimental tool to probe the fear extinction brain network. Study participants will complete fMRI
scanning before and after receiving manualized EX/RP. The EX/RP protocol will consist of 8 (90 minute) daily
sessions comprised of two introductory and six exposure sessions. Women will be randomly assigned to
complete EX/RP during either: a) the first 10 days after the start of menstruation (early follicular phase), when
E levels are low; or b) days 12-22 of the menstrual cycle (late follicular, early luteal phase), when E levels are
elevated. OCD symptoms and E levels will be measured at multiple time points. This design will allow us to
study the effects of hormonal variation during the menstrual cycle and sex on the fear extinction network and
on EX/RP outcome. The results will elucidate treatment mechanisms and could lead to personalized treatment
recommendations for women with OCD.
认知行为疗法包括暴露和仪式预防(EX/RP)是一线治疗,
强迫症(OCD)。尽管EX/RP有效,但仍不清楚EX/RP如何影响神经系统
恐惧和焦虑大脑网络的机制,以产生临床改善。此外,数据显示,
EX/RP结果在女性中可能更多变。对啮齿动物和健康人的研究表明,
(E)影响与恐惧学习、消退和消退保持(恐惧消退)有关的大脑区域
网络); E也被证明可以增强消退记忆保持。此外,结构和
这些相同的大脑区域的连通性预测OCD治疗结果,包括EX/RP。这些和其他
数据导致的假设,这一合作R 01将开始测试:
高E状态下的强迫症通过增强恐惧的参与来改善消退记忆的保持
灭绝大脑网络,从而获得更好的临床结果。我们还将探讨EX/RP是否引起
灭绝过程在男女之间不同。我们的具体目标是研究:1)
月经周期时相和性别对EX/RP前后预激诱导的神经反应的影响; 2)
月经周期时相和性别对EX/RP结局的影响; 3)强迫症症状改变与
和EX/RP诱导的神经元变化。我们的长期目标是了解性作为一个生物学变量
影响特定的神经过程,因此影响EX/RP治疗结果。为了实现我们的目标,120名成年人
OCD - 80名自然自行车女性和40名男性-将在两个地点招募:
宾夕法尼亚大学(UPenn)和纽约州立精神病研究所/哥伦比亚大学(NYSPI)。通过
此外,纽约大学(NYU)将提供功能磁共振成像范例的专业知识,
作为探索恐惧消退大脑网络的实验工具。研究参与者将完成fMRI
在接收手动EX/RP之前和之后进行扫描。EX/RP方案将包括每日8次(90分钟)
会议包括两次介绍会和六次接触会。女性将被随机分配到
完全EX/RP期间:a)月经开始后的前10天(卵泡早期),当
E水平低;或B)月经周期的第12-22天(卵泡晚期、黄体早期),此时E水平低,
升高。将在多个时间点测量OCD症状和E水平。这种设计将使我们能够
研究月经周期和性别对恐惧消退网络的影响,
关于EX/RP结果。结果将阐明治疗机制,并可能导致个性化治疗
对患有强迫症的女性的建议。
项目成果
期刊论文数量(0)
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会议论文数量(0)
专利数量(0)
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{{ truncateString('EDNA B FOA', 18)}}的其他基金
2/2 Harnessing Hormonal Variation to Probe Neural Mechanisms and Optimize CBT Outcomes for OCD
2/2 利用荷尔蒙变化来探索神经机制并优化强迫症的 CBT 结果
- 批准号:
10052122 - 财政年份:2021
- 资助金额:
$ 68.17万 - 项目类别:
2/2 Harnessing Hormonal Variation to Probe Neural Mechanisms and Optimize CBT Outcomes for OCD
2/2 利用荷尔蒙变化来探索神经机制并优化强迫症的 CBT 结果
- 批准号:
10477932 - 财政年份:2021
- 资助金额:
$ 68.17万 - 项目类别:
Treatment of Smoking Among Individuals with PTSD
创伤后应激障碍 (PTSD) 患者吸烟的治疗
- 批准号:
8074405 - 财政年份:2008
- 资助金额:
$ 68.17万 - 项目类别:
Treatment of Smoking Among Individuals with PTSD
创伤后应激障碍 (PTSD) 患者吸烟的治疗
- 批准号:
7579459 - 财政年份:2008
- 资助金额:
$ 68.17万 - 项目类别:
Treatment of Smoking Among Individuals with PTSD
创伤后应激障碍 (PTSD) 患者吸烟的治疗
- 批准号:
8265316 - 财政年份:2008
- 资助金额:
$ 68.17万 - 项目类别:
Treatment of Smoking Among Individuals with PTSD
创伤后应激障碍 (PTSD) 患者吸烟的治疗
- 批准号:
7690281 - 财政年份:2008
- 资助金额:
$ 68.17万 - 项目类别:
Treating Adolescents with CSA-Related PTSD
治疗患有 CSA 相关 PTSD 的青少年
- 批准号:
7452389 - 财政年份:2006
- 资助金额:
$ 68.17万 - 项目类别:
Treating Adolescents with CSA-Related PTSD
治疗患有 CSA 相关 PTSD 的青少年
- 批准号:
7849521 - 财政年份:2006
- 资助金额:
$ 68.17万 - 项目类别:
Treating Adolescents with CSA-Related PTSD
治疗患有 CSA 相关 PTSD 的青少年
- 批准号:
7282515 - 财政年份:2006
- 资助金额:
$ 68.17万 - 项目类别:
Treating Adolescents with CSA-Related PTSD
治疗患有 CSA 相关 PTSD 的青少年
- 批准号:
7104085 - 财政年份:2006
- 资助金额:
$ 68.17万 - 项目类别:
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