Development of a novel exercise threat attentional bias assay

摘要 与心脏相关的变化会增加心血管疾病的风险以及其他健康风险，如 虚弱、福尔斯和痴呆。运动有助于减缓与年龄相关的心脏变化的进展 并且是心脏康复（CR）的重要组成部分，这是一项二级预防计划，用于 加速心脏病或外科手术后的恢复。然而，大多数入组CR的患者 只参加了一部分会议，大多数参加会议的人都没有保持足够的身体健康水平。 CR计划后的活动。焦虑是最早和最强烈的心理反应， 急性CVD。“运动焦虑”，即，害怕和避免身体活动-可能特别相关， 成功CR。从认知行为框架来看，存在心脏相关症状或共病 条件可以提高个人对身体感觉的意识，促进恐惧和对健康的担忧， 安全，并导致运动回避。我们开发了一个手动的，理论上知情的，认知行为的 一项名为内感受性耐受行为暴露（BE-FIT）的干预措施，旨在针对运动 CR患者的焦虑。完全授权的父母补助金（R 01 AG 070136 - 01 A1）包括仔细检查 认知，行为和生理机制，有助于运动焦虑，并作为重要的 治疗目标。父母补助金中缺少的是对信息处理缺陷的仔细检查， 反映了对威胁的偏见，这是焦虑病理学的核心特征，可以通过注意力偏差（AB）进行评估 任务关于AB威胁的文献已经证明，与非焦虑相比，焦虑的个体 在一系列焦虑症中表现出与威胁相关的注意力偏差，有证据表明， 偏见是对干预的反应。但是，相对没有研究考虑AB如何与运动有关 威胁刺激可以影响身体活动行为。我们建议AB向运动和医疗- 相关刺激与CR患者的情境相关，并且可以促成并维持运动焦虑， 这反过来又会破坏锻炼和身体活动的参与。与NOT-OD-22-140一致，我们 我计划开发和验证一种新的检测方法，以进一步评估我们目前的治疗机制。 随机对照试验，并评估这种机制是否与干预研究的主要效应（疗效）有关， 行为启动和维持的过程。具体来说，我们建议开发一个修改后的Stroop任务， 检查参加CR的患者对运动威胁的基础注意偏差，检查其与验证的 自我报告措施的恐惧运动的感觉和心脏为重点的焦虑，并测试以及是否这些 威胁偏见作为干预的函数而改善。通过开发和管理一种新的修改Stroop任务， 为了研究威胁偏见，我们将能够阐明威胁偏见作为一种潜在的行动机制，可以帮助 为了更好地了解BE-FIT干预如何工作（或不工作），以改变运动和身体状况， CR中的活动行为。

ABSTRACT Age-related changes to the heart increase risk for cardiovascular disease as well as other health risks, such as frailty, falls, and dementia. Exercise helps to slow the progression of aging-associated changes to the heart and is an essential component cardiac rehabilitation (CR), which is a secondary prevention program used to speed recovery from cardiac events or surgical procedures. However, the majority of patients who enroll in CR only attend a portion of sessions and the majority that do attend fail to maintain sufficient levels of physical activity after the CR program. Anxiety is among the earliest and most intense psychological reactions following acute CVD. “Exercise anxiety”, i.e., fear and avoidance of physical activity – may be particularly relevant to successful CR. From a cognitive-behavioral framework, the presence of heart-related symptoms or comorbid conditions can heighten individuals’ awareness of bodily sensations, promote fear and worry about health and safety, and lead to exercise avoidance. We developed a manualized, theoretically-informed, cognitive-behavioral intervention called Behavioral Exposure For Interoceptive Tolerance (BE-FIT) designed to target exercise anxiety in CR patients. The fully powered parent grant (R01AG070136-01A1) includes careful examination of cognitive, behavioral and physiological mechanisms that contribute to exercise anxiety and serve as important treatment targets. Missing from the parent grant is a careful examination of deficits in information processing that reflect a bias toward threat, a core feature of anxiety pathology that can be assessed via attentional bias (AB) tasks. The literature on AB to threat has documented that anxious, compared to non-anxious, individuals exhibit threat related attentional biases across a range of anxiety disorders and there is evidence that these biases are responsive to intervention. However, relatively no work has considered how AB to exercise-related threat stimuli could influence physical activity behavior. We propose that AB towards exercise and medical- related stimuli is contextually relevant to patients in CR, and can contribute to and maintain exercise anxiety, which in turn, can undermine exercise and physical activity participation. Consistent with NOT-OD-22-140, we plan to develop and validate a new assay in order to further assessment treatment mechanism in our current RCT, and evaluate whether this mechanism is related to the intervention study’s main effect (efficacy) over the course of behavior initiation and maintenance. Specifically, we propose to develop a modified Stroop task to examine basal attentional bias to exercise threat in patients attending CR, examine its relations with validated self-report measures of fear about exercise sensations and heart-focused anxiety, and test well as whether these threat biases improve as a function of intervention. By developing and administering a novel modified Stroop task to examine threat bias, we will be able illuminate the threat bias as a potential mechanism of action that can help to better understand how the BE-FIT intervention works (or does not work) to change exercise and physical activity behavior in CR.