Massage for GAD: Neuroimaging and clinical correlates of response

GAD是一种情绪反应性增强的障碍，其主要症状是持续担忧，包括 减少情绪对反差的负面情绪的反应的回避机制。循证的 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 抗抑郁药是治疗广泛性焦虑症的有效药物；然而，需要额外的可接受的、 广泛性广泛性焦虑症患者的治疗方法。按摩是数十亿美元 2016-2017年间，超过4710万美国成年人至少接受了一次按摩。按摩是 通常用来增加整体幸福感和减少焦虑，我们组有 调查瑞典推拿疗法(SMT)对精神症状和生理的影响。在一辆6- 每周两次的SMT与轻触(LT)对照对GAD、SMT的周研究结果具有统计学意义 减少焦虑和抑郁-表明SMT具有生物活性，可以影响症状 焦虑。尽管GAD中的成像结果仍然不一致，但 皮质边缘回路(杏仁核、前扣带回(ACC)、前额叶皮质(PFC))是最常见的脑区之一 一致的发现。目前，还没有任何脑部成像研究调查任何类型的 身体按摩对大脑功能的影响。该提案的总体目标是确定受影响的神经网络 对广泛性焦虑症患者进行全身按摩。这项研究是一项双臂随机掩蔽研究。 探讨SMT与LT对照对广泛性AD患者脑活动的影响。身体健康 受试者为18岁的广泛性痴呆患者，先进行功能磁共振检查，然后进行每周2次的≥(n=20)或LT(n=20)。 几周后，进行第二次功能磁共振检查。恐惧/愤怒时的休眠状态功能连接(RsFC)和FC 面孔任务将被评估。目标1是使用静息状态来识别SMT和LT激活的大脑网络 广泛性阿尔茨海默病患者恐惧面孔任务时的fMRI和Fc。主要的假设是相对于 LT控制，SMT将导致治疗前到治疗后rsFC在已知的 因焦虑症而改变。第二，与LT对照组相比，接受SMT的受试者将表现出更少的症状 对恐惧/愤怒面孔任务的激活，以及治疗前后较大幅度的下降 大脑激活。最后，假设治疗前后rsfc的增加将呈负相关。 随着HAM-A评分的变化而减少，而治疗前和治疗后的脑激活在 对恐惧/愤怒面孔任务的反应将与以下方面的HAM-A分数的下降呈正相关 两组均为治疗组。这项研究的完成将提供第一批评估SMT治疗效果的fMRI数据 与主动控制条件的比较，在大脑连接和活动的特定区域的受试者 盖德。

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.