An Approach-Avoidance, Computational Framework for Predicting Behavioral Therapy Outcome in Anxiety and Depression

项目摘要 抑郁症和焦虑症是高度共病的，排在前十位的原因，多年来生活在一起 残疾。目前的黄金标准治疗是有效的，但并不像我们希望的那样有效， 超过50%的人经历了长期的改善。抑郁症的两种金标准行为干预 和焦虑包括行为激活，侧重于增强接近行为， 强化活动和基于焦虑的治疗，侧重于减少回避和挑战消极 通过暴露于引发焦虑的线索或情况来达到预期。虽然这些干预措施 分歧的方法与避免治疗目标，目前很少有知识，以指导临床 决策，即，告知在常见的共病焦虑病例中应提供哪些策略 和抑郁症状。接近-回避决策范式侧重于评估神经和 行为反应时，面对潜在的奖励和威胁，挖掘过程，虽然是 对焦虑和抑郁以及行为激活和基于焦虑的治疗都很重要。 在这项研究中，我们将招募同时报告焦虑和抑郁症状的个体， 将他们随机分配到三种不同的心理治疗干预措施中的一种，包括 (1)行为激活，（2）基于确定性的治疗，和非特异性治疗方法（3）支持性 疗法参与者将完成临床、自我报告、行为和功能磁共振成像 （fMRI）评估治疗前后。临床症状也将评估三个月和六个月 治疗完成后。我们将使用一种计算方法来模拟不同的因素， 影响一个人在接近-回避决策过程中的行为，包括避免威胁的驱动力， 在一个人的决定中，接近奖励和信心与不确定性。 本研究的主要目的是：（1）确定大脑和行为的变化 在接近-回避冲突过程中的反应与心理健康症状的变化有关， 治疗方法，（2）确定基线大脑和行为反应的程度， 接近-回避冲突预测对不同治疗方法的反应，高于和超过 人口统计学和基线症状严重程度的影响。 研究结果将增强我们对不同心理治疗方法（行为疗法）的理解。 激活，基于确定性的治疗）可能会影响大脑的反应和决策时，面对潜在的 奖励与威胁，接近与回避驱动。此外，结果将具有重要意义。 关于心理治疗更个性化方法的潜力的影响， 了解哪些类型的治疗策略可能对哪些个体最有益。

PROJECT SUMMARY Depression and anxiety disorders are highly comorbid and rank in the top ten causes of years lived with disability. Current gold-standard treatments are effective but do not work as well as we would like, with less than 50% experiencing long-lasting improvements. Two gold-standard behavioral interventions for depression and anxiety include behavioral activation, focused on enhancing approach behavior towards meaningful and reinforcing activities, and exposure-based therapy, focused on decreasing avoidance and challenging negative expectations through exposure to anxiety-provoking cues or situations. While these interventions have divergent approach versus avoidance treatment targets, there is currently little knowledge to guide clinical decision-making, i.e., to inform which strategies should be provided in the frequent case of comorbid anxiety and depression symptoms. Approach-avoidance decision-making paradigms focus on assessing neural and behavioral responses when faced with potential rewards and threats, tapping into processes though to be important for both anxiety and depression as well as behavioral activation and exposure-based therapy. For this study, we will recruit individuals reporting both anxiety and depression symptoms and randomize them to one of three different psychotherapeutic interventions delivered in a group setting, including (1) behavioral activation, (2) exposure-based therapy, and a non-specific therapy approach (3) supportive therapy. Participants will complete clinical, self-report, behavioral, and functional magnetic resonance imaging (fMRI) assessments before and after therapy. Clinical symptoms will also be assessed three and six months following therapy completion. We will use a computational approach to model the different factors that may influence one’s behavior during approach-avoidance decision-making, including drives to avoid threat versus approach reward and confidence versus uncertainty in one’s decisions. This project will accomplish the following aims (1) Determine how changes in brain and behavior responses during approach-avoidance conflict relate to changes in mental health symptoms with the different therapy approaches, (2) Determine the degree to which baseline brain and behavior responses during approach-avoidance conflict predict response to the different therapy approaches, above and beyond the influence of demographics and baseline symptom severity. Results will have enhance our understanding of how different psychotherapy approaches (behavioral activation, exposure-based therapy) may impact brain responses and decisions when faces with potential reward versus threat and approach versus avoidance drives. In addition, results will have important implications concerning the potential for a more personalized approach to psychotherapy, enhancing knowledge of which types of therapy strategies may be most beneficial for which individuals.