The Effect of Mindfulness-Based Cognitive Therapy on ERP Markers of Attentional Bias in Anxiety

项目摘要/摘要 在过去的一年里，据估计，美国18岁或以上的成年人中有19.1%患有焦虑症， 据估计，31.1%的美国成年人在生活中的某个时候经历过焦虑症。截至2010年， 焦虑症是导致多年来残疾的第五大原因。焦虑症与 对威胁的注意偏向，指的是对威胁刺激的不同注意分配 相对于中性刺激。焦虑的人在早期的、自动的阶段将他们的注意力引导到威胁上 而在更晚的、更具战略意义的处理阶段，他们倾向于引导他们的注意力 远离威胁。注意偏差可能会延长焦虑状态，因为它会过度优先考虑潜在威胁 在环境中，从而加剧焦虑情绪状态。在点探测(DP)范式中，具有社会功能的个体 焦虑症的P1波幅增加到愤怒中性的面孔对，而不是快乐中性的面孔对，这表明 早期对愤怒的面孔保持高度警惕，并降低P1波幅以取代情绪(愤怒和 快乐)与中性面孔相比，表明稍后情绪显著位置的视觉处理减少 信息处理阶段--可能是注意回避的一种表现。冥想练习有 建议通过提高参与和脱离的效率来改善注意力的控制 过程，从而减少注意力的偏向。在对纤维肌痛患者使用DP任务的初步工作中， 正念干预在加工的早期水平减少了疼痛相关威胁的避免，并促进了 在处理的后期阶段脱离威胁。基于这些令人鼓舞的发现，目前的 应用程序希望调查基于正念的认知疗法(MBCT)是否可以改变P1威胁- 具有临床焦虑水平的患者在DP任务中的相关注意偏差标记物，以及MBCT- 对P1标志物的诱导修改是治疗收益的原因。拟议的研究旨在(1) 确定为期8周的MBCT是否改变了焦虑患者的P1威胁相关注意偏差标记物， (2)探讨P1威胁相关注意偏向标记物与急性治疗的关系 响应能力和耐用性。将从以下人员中招募42名具有中度到高度特质焦虑的个人 在Osher中西医结合中心(OCIM)使用状态特征进行的开放标签MBCT试验 焦虑问卷(STAI)。干预前后，P1标记对DP中的线索和探针的反应幅度 任务将受到监控。焦虑症状等级将使用抑郁焦虑应激量表进行评估 (DASS)作为主要结果，以及STAI和临床全球委员会的二次评估 印象(CGI)量表。治疗耐受性还将通过DASS、STAI和CGI进行六个月的评估 MBCT干预后。这项拟议的研究将为潜在的生理机制提供洞察。 通过它，MBCT可以针对注意偏差的早期和后期，并减少临床症状 焦虑。此外，还将探讨抑郁和应激对MBCT诱导的标志物修饰的影响。

PROJECT SUMMARY/ABSTRACT In the past year, an estimated 19.1% of adults aged 18 or older in the United States had an anxiety disorder, and an estimated 31.1% of U.S. adults experience any anxiety disorder sometime in their lives. As of 2010, anxiety disorders were the fifth leading cause of years lived with disability. Anxiety disorders are associated with attentional bias to threat, which refers to differential attentional allocation towards threatening stimuli relative to neutral stimuli. Anxious individuals direct their attention toward threat during early, automatic stages of processing, whereas during later, more strategic stages of processing, they tend to direct their attention away from threat. Attentional bias may prolong anxiety states by placing inordinate priority on potential threats in the environment, thus intensifying anxious mood states. In a dot-probe (DP) paradigm, individuals with social anxiety disorder display enhanced P1 amplitudes to angry–neutral versus happy–neutral face pairs, suggesting early hypervigilance to angry faces, and decreased P1 amplitudes to probes replacing emotional (angry and happy) versus neutral faces, suggesting reduced visual processing of emotionally salient locations at later stages of information processing—potentially a manifestation of attentional avoidance. Meditation practice has been proposed to improve the control of attention by improving efficiency of engagement and disengagement processes, thereby reducing bias of attention. In preliminary work using a DP task with fibromyalgia patients, a mindfulness intervention reduced avoidance of pain-related threat at early levels of processing and facilitated disengagement from threat at later stages of processing. Building on these encouraging findings, the current application wishes to investigate whether Mindfulness-based Cognitive Therapy (MBCT) can modify P1 threat- related attentional bias markers in a DP task in patients with clinical levels of anxiety, and whether MBCT- induced modification of P1 markers account for treatment gains. The proposed research is designed (1) to determine whether an 8-week MBCT modifies P1 threat-related attentional bias markers in anxious patients, and (2) to investigate the relationship between P1 threat-related attentional bias markers, acute treatment response and durability. Forty-two individuals with moderate to high levels of trait anxiety will be recruited from an ongoing trial of open-label MBCT at the Osher Center for Integrative Medicine (OCIM) using the State-Trait Anxiety Inventory (STAI). Before and after intervention, P1 marker amplitudes to cues and probes in the DP task will be monitored. Anxiety symptom levels will be evaluated using the Depression Anxiety Stress Scale (DASS) as the primary outcome along with secondary evaluation by the STAI and the Clinical Global Impression (CGI) Scale. Treatment durability will also be assessed with the DASS, STAI, and CGI six months after MBCT intervention. The proposed research will provide insight into a potential physiological mechanism through which MBCT may target early and later stages of attentional bias and reduce clinical symptoms of anxiety. The effect of depression and stress on MBCT-induced marker modification will also be explored.