Reward Sensitivity as a Mechanism of Positive Affect Treatment for Anhedonia

奖励敏感性作为快感缺失积极情感治疗的机制

• 批准号: 10636631
• 负责人: MICHELLE G CRASKE
• 金额: $ 79.83万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636631
• 关键词: Address; Affect; Aftercare; Anhedonia; Anxiety; Behavior; Behavioral; Cellular Phone; Characteristics; Clinical; Compassion; Depressed mood; Desire for food; Diagnostic; Dose; Effectiveness; Feeling suicidal; Goals; Individual; Investigational Therapies; Learning; Love; Measures; Mediating; Mediation; Mediator; Mental Depression; Motivation; Outcome; Participant; Patient Self-Report; Pharmacological Treatment; Phase; Physical activity; Physiological; Pilot Projects; Positioning Attribute; Positive Valence; Process; Protocols documentation; Randomized; Research; Research Domain Criteria; Rewards; Schizophrenia; Signal Transduction; Social Interaction; Specificity; Stimulus; Stress; Substance abuse problem; Suicide; Symptoms; System; Technology; Testing; Therapeutic; Training; affective neuroscience; anxious; cognitive training; design; dosage; effective therapy; follow-up; functional disability; gratitude; high risk; improved; indexing; interest; negative affect; novel; overtreatment; pleasure; psychologic; psychosocial; remote monitoring; reward processing; suicidal behavior; therapy design; treatment comparison; treatment response

PROJECT SUMMARY Anhedonia, or loss of interest or pleasure in usual activities, is characteristic of depression, some types of anxiety, as well as substance abuse and schizophrenia. Anhedonia is a predictor of poor long term outcomes, including suicide, and poor treatment response. Extant psychological and pharmacological treatments are relatively ineffective for anhedonia. Thus, there is an unmet therapeutic need for this high-risk symptom. Recent advances in affective neuroscience have elucidated processes that may underlie anhedonia and should be targeted in therapy. Specifically, anhedonia is associated with deficits in the appetitive reward system, including (1) reward approach-motivation, (2) initial responsiveness to reward attainment, and (3) learning of reward. We have developed a novel transdiagnostic psychosocial treatment for anhedonia, Positive Affect Treatment (PAT), designed to improve deficits in reward sensitivity. In our pilot study of 61 depressed or anxious and functionally impaired individuals we found a strong preliminary efficacy signal and evidence for treatment specificity. Specifically, PAT led to significant improvements in symptoms of anhedonia, depression and anxiety and was more effective for individuals with anhedonia at baseline than a treatment designed to reduce negative affect. The proposed application uses an experimental therapeutics approach to elucidate whether reward approach- motivation, initial responsiveness to reward attainment or reward learning change with PAT (i.e., target engagement) in the R61 phase, and to evaluate whether changes in reward sensitivity mediate outcomes from PAT in the R33 phase. In the R61 phase, 68 individuals with anhedonia who are anxious or depressed and functionally impaired will be randomized to single-dose PAT (15 weekly sessions) or double dose PAT (PAT- DD, 30 twice-weekly sessions). Physiological, behavioral, and self-report measures of reward approach- motivation, initial reward responsiveness, and learning will be assessed repeatedly. Outcomes include clinician and self-report measures of anhedonia and ecologically valid measures of functional impairment (i.e., physical activity and social interaction). Progression to R33 depends on post-treatment average anhedonia scores that are within 1 SD of the norm, and significant (effect size > .8) pre- to post-treatment changes in reward approach- motivation, initial responsiveness to attainment or learning, which covary significantly with anhedonia over treatment. The treatment dose that produces significantly greater pre- to post-treatment change in one or more target measures will be carried forward to R33. In the R33 phase, 100 individuals will be randomized to PAT (or PAT-DD) or to Negative Affect Treatment; the latter designed to reduce threat sensitivity. Indices of reward sensitivity (from R33 phase) and threat sensitivity will be evaluated as mediators of PAT and moderated mediation will be tested by comparing reward sensitivity mediation in PAT vs NAT. If successful, PAT will offer a viable and effective treatment for individuals with anhedonia, and the results will elucidate the mechanisms responsible for the effectiveness of this novel treatment.

项目摘要 快感缺乏，或失去兴趣或乐趣，在日常活动中，是抑郁症的特征，某些类型的抑郁症， 焦虑症，以及药物滥用和精神分裂症。快感缺乏是长期预后不良的预测因子， 包括自杀和治疗效果不佳现存的心理和药物治疗是 对快感缺乏相对无效。因此，这种高风险症状的治疗需求尚未得到满足。最近 情感神经科学的进展已经阐明了可能导致快感缺乏的过程， 治疗中的目标。具体来说，快感缺乏与食欲奖励系统的缺陷有关，包括 (1)奖励接近动机，（2）对奖励获得的初始反应，（3）奖励的学习。我们 开发了一种新的跨诊断的心理治疗快感缺失，积极的情感治疗（PAT）， 旨在改善奖励敏感性的缺陷。在我们对61名抑郁或焦虑， 对于受损的个体，我们发现了强烈的初步疗效信号和治疗特异性的证据。 具体而言，PAT导致快感缺乏、抑郁和焦虑症状的显著改善， 对基线时有快感缺失的个体比旨在减少负面影响的治疗更有效。 拟议的应用程序使用实验治疗方法来阐明奖励方法是否- 动机、对奖励获得的初始反应或奖励学习随PAT变化（即，目标 参与），并评估奖励敏感性的变化是否介导了 R33阶段的PAT。在R61阶段，68名焦虑或抑郁的快感缺乏症患者， 功能受损的患者将被随机分配至单次剂量PAT（15周一次）或双倍剂量PAT（PAT- DD，30次，每周两次）。生理，行为和自我报告的奖励方法的措施- 动机、初始奖励反应和学习将被反复评估。结局包括临床医生 以及快感缺乏的自我报告测量和功能损害的生态有效测量（即，物理 活动和社会互动）。进展至R33取决于治疗后平均快感缺失评分， 在标准值的1 SD内，并且奖励方法的治疗前后变化显著（效应量> .8）- 动机，对成就或学习的初始反应，这些与快感缺乏显著相关， 治疗在一种或多种疾病中产生显著更大的治疗前后变化的治疗剂量 目标措施将延续到R33。在R33阶段，100名个体将被随机分配至PAT（或 PAT-DD）或负面情绪治疗;后者旨在降低威胁敏感度。奖励指数 敏感性（来自R33阶段）和威胁敏感性将作为PAT的中介进行评估， 将通过比较PAT与NAT中的奖励敏感度调解来测试调解。如果成功，PAT将提供 一个可行的和有效的治疗个人与快感缺失，结果将阐明机制 对这种新疗法的有效性负责。

项目成果

Stress-induced cortisol reactivity as a predictor of success in treatment for affective dimensions.

• DOI: 10.1016/j.psyneuen.2020.104646
• 发表时间: 2020-06
• 期刊: Psychoneuroendocrinology
• 影响因子: 3.7
• 作者: Roque AD;Craske MG;Treanor M;Rosenfield D;Ritz T;Meuret AE
• 通讯作者: Meuret AE

A method to study protein biomarkers in saliva using an automated capillary nano-immunoassay platform (Wes™).

• DOI: 10.1016/j.jim.2020.112749
• 发表时间: 2020-01
• 期刊: Journal of immunological methods
• 影响因子: 2.2
• 作者: E. Reyes-Serratos;M. Marcet-Palacios;D. Rosenfield;T. Ritz;A. Befus

Positive affect treatment targets reward sensitivity: A randomized controlled trial.

积极情感治疗目标奖励敏感性：一项随机对照试验。

• DOI: 10.1037/ccp0000805
• 发表时间: 2023
• 期刊: Journal of consulting and clinical psychology
• 影响因子: 5.9
• 作者: Craske,MichelleG;Meuret,AliciaE;Echiverri-Cohen,Aileen;Rosenfield,David;Ritz,Thomas
• 通讯作者: Ritz,Thomas