The Role of Effort Discounting in the Link between Insomnia and Depression

努力折扣在失眠和抑郁之间的联系中的作用

• 批准号: 10563118
• 负责人: Elaine M Boland
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10563118
• 关键词: Adult; Affect; Aftercare; Age; Behavior; Behavioral; Behavioral inhibition; Caring; Clinical; Clinical Practice Guideline; Clinical Trials; Cognitive Therapy; Comorbid Insomnia; Depressed mood; Development; Ensure; Exhibits; Expenditure; Future; Health; Individual; Intervention; Lead; Learning; Link; Measures; Mental Depression; Mental Health; Mentors; Methods; Mood Disorders; Neurosciences; Outcome; Participant; Pathway interactions; Patient Self-Report; Play; Prevalence; Process; Psychopathology; Punishment; Quality of life; Questionnaires; Randomized; Research; Resistance; Reversal Learning; Rewards; Robin bird; Role; Scientist; Severities; Sleep; Sleep disturbances; Sleeplessness; Specificity; Suicide; Symptoms; Testing; Therapeutic; Training; Translational Research; Veterans; Waiting Lists; actigraphy; antidepressant effect; behavior measurement; biopsychosocial; career; clinically significant; comorbid depression; diaries; discounting; experience; improved; innovation; novel; preference; programs; recruit; relapse risk; research study; reward processing; secondary analysis; severe mental illness; sleep health; statistics; tool; treatment guidelines

Two-thirds of individuals with depression have also been shown to meet criteria for insomnia, the presence of which is associated with poor clinical course, greater resistance to depression treatment and an increased risk for relapse and suicidality. Research aimed at identifying the shared biopsychosocial processes relevant to both depression and insomnia is necessary to develop the therapeutic tools to reduce these negative outcomes and improve the health and quality of life of Veterans. The proposed CDA-2 targets reward processing, specifically the processing of reward-relevant effort, as one such commonality. Individuals with depression have been shown to engage more readily in effort discounting than non-depressed individuals, meaning that they are more likely to devalue rewards that require greater effort to obtain. There is some preliminary evidence that sleep disturbance may lead to effort discounting, but this effect has not been tested in adults with clinically significant insomnia, nor have previous studies of effort discounting in depression adequately characterized the severity and prevalence of insomnia among participants. This CDA-2 aims to evaluate the extent to which the processing of reward-relevant effort is meaningfully related to insomnia. The study will involve 132 Veterans ages 18 – 55 selected to represent a continuum of depression and insomnia symptom severity utilizing a quadrant approach. This approach will ensure a good distribution of Veterans with low insomnia/low depression, high insomnia/low depression, low insomnia/ high depression, and high insomnia/high depression severity for an analysis that utilizes continuous predictors to maximize power and explore the component effects of insomnia and depression on effort discounting. Veterans will participate in a week of subjective (sleep diary) and objective (actigraphy) assessments of sleep followed by assessments of effort discounting. Effort discounting will be measured with the Effort Expenditure for Rewards and the Progressive Ratio Tasks, behavioral measures that provide estimates of the effort subjects are willing to put forth for monetary rewards. To assess the specificity of the relationship of insomnia and reward processing, Veterans will also complete the delayed discounting task (a measure of reward valuation), and the probabilistic reversal learning task (a measure of reward learning). The Behavioral Inhibition/Behavioral Activation Scales and The Sensitivity to Punishment/Sensitivity to Reward Questionnaire are self-report measures of reward sensitivity and will also be administered. Veterans with clinically significant insomnia (i.e., Veterans in the high insomnia/low depression and high insomnia/high depression groups) will be randomly assigned to Cognitive Behavioral Therapy for Insomnia (CBT-I) or to a 6-week waitlist control period, after which they will receive CBT-I. Post-treatment/waitlist assessments of sleep and reward processing will be conducted to explore whether changes in insomnia severity are related to both changes in depression and effort discounting. Insomnia is hypothesized to be related to increased effort discounting (i.e., reduced effort to pursue rewards), and improvements in insomnia are hypothesized to be correlated with both improvements in depression and reduced effort discounting. As assessments of the specificity of the insomnia/effort discounting relationship are exploratory, there are no a priori hypotheses as to the effects of insomnia on reward valuation or learning. This CDA-2 will provide the applicant with focused training in translational sleep and mental health research (primary mentor Dr. Philip Gehrman), clinical trial methods and advanced statistics (co-mentor Dr. Michael Thase), assessment and analysis of reward guided behavior (co-mentor Dr. Robin Nusslock) and grantsmanship and professional development (co-mentor Dr. Steven Sayers). Findings from this study could enhance clinical practice guidelines for the treatment of Veterans with depression and insomnia.

三分之二的抑郁症患者也被证明符合失眠的标准， 它的存在与不良的临床过程，对抑郁症治疗的更大抵抗力和 复发和自杀的风险增加。旨在确定共同的生物心理社会过程的研究 与抑郁症和失眠症相关的研究是必要的，以开发治疗工具，以减少这些 改善退伍军人的健康和生活质量。拟议的CDA-2目标是奖励 处理，特别是与奖励相关的努力的处理，作为这样一个共性。人士 研究表明，抑郁症患者比非抑郁症患者更容易出现努力折扣， 这意味着他们更有可能贬低需要付出更大努力才能获得的奖励。有一些 初步证据表明，睡眠障碍可能会导致努力折扣，但这种影响尚未得到验证 在临床上有显著失眠的成年人中，以前关于抑郁症中努力折扣的研究也没有 充分描述了参与者失眠的严重程度和患病率。该CDA-2旨在 评估奖励相关努力的处理与失眠有意义相关的程度。 这项研究将涉及132名年龄在18 - 55岁之间的退伍军人，他们被选为抑郁症的代表， 失眠症状严重程度使用象限方法。这种方法将确保良好的分布， 低失眠/低抑郁，高失眠/低抑郁，低失眠/高抑郁， 高失眠/高抑郁严重程度，用于利用连续预测因子进行分析以最大化功效 探讨失眠和抑郁对努力折扣的影响。退伍军人将参加 在一周的主观（睡眠日记）和客观（活动记录）睡眠评估中， 努力折扣。努力折扣将通过奖励的努力支出和 累进比率任务，提供受试者愿意付出的努力的估计的行为测量 为了金钱上的回报。为了评估失眠和奖励处理之间关系的特异性， 退伍军人还将完成延迟贴现任务（奖励估值的一种衡量方法），以及概率 反向学习任务（一种奖励学习的方法）。行为抑制/行为激活量表 惩罚敏感度/奖励敏感度问卷是自我报告的奖励措施 敏感性，并将被管理。具有临床显著失眠的退伍军人（即，退伍军人在高 失眠/轻度抑郁组和高度失眠/高度抑郁组）将被随机分配至认知障碍组（认知障碍组）。 行为疗法的抑制（CBT-I）或6周的等待名单控制期，之后他们将获得 CBT-I将进行睡眠和奖励处理的治疗后/等待名单评估，以探索 失眠严重程度的变化是否与抑郁和努力折扣的变化有关。 假设Increment与增加的努力折扣有关（即，减少追求奖励的努力）， 失眠的改善被假设与抑郁的改善相关， 减少折扣。由于失眠/努力折扣关系的特异性评估是 探索性的，有没有一个先验的假设，失眠对奖励价值或学习的影响。 该CDA-2将为申请人提供翻译睡眠和心理健康方面的重点培训 研究（主要导师Philip Gehrman博士）、临床试验方法和高级统计学（共同导师Philip Gehrman博士）。 Michael Thase），奖励引导行为的评估和分析（共同导师Robin Nusslock博士）， granitarian和专业发展（共同导师博士史蒂芬塞耶斯）。这项研究的结果可以 加强治疗退伍军人抑郁症和失眠症的临床实践指南。

项目成果

Antidepressant effects of acute sleep deprivation are reduced in highly controlled environments.

在高度控制的环境中，急性睡眠剥夺的抗抑郁作用会降低。

• DOI: 10.1016/j.jad.2023.07.116
• 发表时间: 2023
• 期刊: Journal of affective disorders
• 影响因子: 6.6
• 作者: Goldschmied,JenniferR;Boland,Elaine;Palermo,Emma;Barilla,Holly;Dinges,DavidF;Detre,JohnA;Basner,Mathias;Sheline,YvetteI;Rao,Hengyi;Gehrman,Philip
• 通讯作者: Gehrman,Philip

Do financial incentives increase mental health treatment engagement? A meta-analysis.

• DOI: 10.1037/ccp0000737
• 发表时间: 2022-06
• 期刊: JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
• 影响因子: 5.9
• 作者: Khazanov, Gabriela K;Morris, Paige E;Beed, Alexander;Jager-Hyman, Shari;Myhre, Karoline;McKay, James R;Feinn, Richard S;Boland, Elaine M;Thase, Michael E
• 通讯作者: Thase, Michael E

Preliminary support for the role of reward relevant effort and chronotype in the depression/insomnia comorbidity.

初步支持奖励相关努力和时间型在抑郁/失眠共病中的作用。

• DOI: 10.1016/j.jad.2018.08.057
• 发表时间: 2019
• 期刊: Journal of affective disorders
• 影响因子: 6.6
• 作者: Boland,ElaineM;Bertulis,Kassondra;Leong,ShirleyH;Thase,MichaelE;Gehrman,PhilipR
• 通讯作者: Gehrman,PhilipR

Does insomnia treatment prevent depression?

• DOI: 10.1093/sleep/zsad104
• 发表时间: 2023-04-08
• 期刊: SLEEP
• 影响因子: 5.6
• 作者: Boland, Elaine M.;Goldschmied, Jennifer R.;Gehrman, Philip R.
• 通讯作者: Gehrman, Philip R.

Identifying predictors of the amount of veteran participation in cognitive behavioral therapy for insomnia in the Veterans Affairs health care system.

确定退伍军人事务部医疗保健系统中退伍军人参与失眠认知行为治疗的预测因素。

• DOI: 10.1037/ser0000818
• 发表时间: 2023
• 期刊: Psychological services
• 影响因子: 2.3
• 作者: Tighe,CaitlanA;Berlin,GregoryS;Boland,ElaineM;Miller,KatherineE;Bramoweth,AdamD
• 通讯作者: Bramoweth,AdamD