Massage for GAD: Neuroimaging and clinical correlates of response

广泛性焦虑症是一种情绪反应性增加的疾病，其主要症状是持续的担忧，包括 回避机制，减少情绪反应对比消极情绪。循证 研究表明，认知行为疗法（CBT）和选择性5-羟色胺再摄取抑制剂 抗抑郁药是GAD的有效治疗方法;然而，需要额外的可接受的， 广泛适用于患有广泛性焦虑症的患者的治疗方法。按摩是一个数十亿美元的 在2016-2017年，超过4710万美国成年人至少接受过一次按摩。按摩是 通常用于增加整体的幸福感和减少焦虑，我们的团队 研究了瑞典按摩疗法（SMT）对精神症状和生理的影响。在一个6- 每周两次的SMT与轻度接触（LT）对照组的GAD研究，SMT导致统计学显著性差异 减少焦虑和抑郁-证明SMT是生物活性的，可以影响症状 焦虑虽然GAD的成像结果仍然不一致，但在GAD内功能连接（FC）降低， 皮质边缘回路（杏仁核、前扣带皮层（ACC）、前额叶皮层（PFC））是大脑中最重要的回路之一， 一致的发现。目前，还没有研究大脑成像的研究， 身体按摩对大脑功能的影响该提案的总体目标是识别受影响的神经网络 全身按摩治疗广泛性焦虑症本研究是一项双组、随机、设盲研究 研究SMT与LT对照对GAD受试者大脑活动的影响。医学上健康 年龄≥18岁的GAD受试者将接受fMRI，随后接受2周SMT（n=20）或LT（n=20），持续6周 第二次功能性磁共振成像。静息状态功能连接（rsFC）和恐惧/愤怒时的FC 将对任务进行评估。目的1是使用静息状态识别SMT与LT激活的脑网络 广泛性焦虑症受试者恐惧面孔任务的fMRI和FC主要假设是，相对于 LT控制，SMT将导致已知区域之间的rsFC从治疗前到治疗后增加更大。 患有焦虑症其次，相对于LT对照，接受SMT的受试者将表现出更少的 激活响应恐惧/愤怒的面孔任务，以及更大的治疗前到治疗后的减少， 大脑激活最后，假设治疗前至治疗后rsFC的增加将与 HAM-A评分的变化减少，而治疗前至治疗后的大脑激活减少， 对恐惧/愤怒面孔任务的反应将与HAM-A分数的下降呈正相关， 两个治疗组。这项研究的完成将提供第一个功能磁共振成像数据，评估SMT在 与主动控制条件进行比较，在受试者的大脑连接和活动的特定区域上， GAD。

GAD is a disorder of increased emotional reactivity, with its cardinal symptom, persistent worry, comprising an avoidance mechanism that decreases emotional reactivity to contrasting negative emotions. Evidence-based research has shown that both cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitor antidepressants are efficacious treatments for GAD; however, there is a need for additional acceptable, and widely available treatment approaches for patients suffering from GAD. Massage is a multi-billion dollar industry and in 2016-2017, over 47.1 million adult Americans received at least one massage. Massage is commonly used to increase the overall sense of wellbeing and decrease anxiety and our group has investigated the impact of Swedish massage therapy (SMT) on psychiatric symptoms and physiology. In a 6- week study of twice-weekly SMT vs a light touch (LT) control for GAD, SMT caused statistically significant decreases in anxiety and depression - demonstrating that SMT is biologically active and can impact symptoms of anxiety. Although imaging results in GAD remain inconsistent reduced functional connectivity (FC) within the corticolimbic circuit (amygdala, anterior cingulate cortex (ACC), prefrontal cortex (PFC)) is one of the most consistent findings. At this time there are no brain imaging studies investigating the impact of any type of whole body massage on brain function. The overall goal of this proposal is to identify the neural networks impacted by whole body massage in subjects with GAD. This study is a two-arm, randomized, masked study investigating the effects of SMT vs. LT control on brain activity in subjects with GAD. Medically healthy subjects ≥18 years of age with GAD will undergo fMRI followed by 2/week SMT (n=20) or LT (n=20) for 6 weeks, followed by a second fMRI. Resting state functional connectivity (rsFC) and FC during the fearful/angry faces task will be assessed. Aim 1 is to identify brain networks activated by SMT vs. LT using resting state fMRI and FC during the fearful faces task in subjects with GAD. The primary hypothesis is that relative to the LT control, SMT will result in greater pre-to- post-treatment increase in rsFC between areas known to be altered with anxiety disorders. Second, relative to LT control, subjects undergoing SMT will exhibit less activation in response to the fearful/angry faces task, as well as a greater pre-to-post-treatment decrease in brain activation. Lastly, it is hypothesized that pre-to-post-treatment increases in rsFC will inversely correlate with decreases in changes HAM-A scores, whereas pre-to-post-treatment decreases in brain activation in response to the fearful/angry faces task will be positively correlated with decreases in HAM-A scores within both treatment groups. Completion of this study will provide the first fMRI data evaluating the effects of SMT in comparison to an active control condition, on specific areas of brain connectivity and activity in subjects with GAD.