Targeting Attention Orienting to Social Threat to Reduce Social Anxiety in Youth

项目摘要 这个2站点(佛罗里达国际大学、耶鲁大学)R01项目建议确认注意偏差 改良疗法(ABMT)对青春期社交焦虑症(SAD)的有效治疗 年龄在10-14岁的青少年，并研究ABMT的临床疗效机制。悲伤很普遍， 慢性的，有损害的。SAD对循证治疗(EBT)的应答率明显低于 其他焦虑症，关于这些年轻人的积极结果的机制存在有限的见解 一定要对现有的EBTS做出回应。因此，迫切需要替代治疗方案，特别是 NIMH的实验治疗学方法产生的转化神经科学方法。 ABMT就是这样一种方法，因为它植根于认知神经科学的理论和方法来解决 以极快的时间尺度运行的心烦意乱的注意力。根据NIMH的实验 治疗方法，我们在前期工作中收集的数据支持ABMT的可行性和 可接受性，并确定了假定的目标机制。接下来，我们收集了一些数据，证明了 目标(即，目标参与)以及将目标中的变化与临床改进相联系(即，目标 验证)。具体地说，我们收集了事件相关电位中有针对性的快速部署过程的数据 (ERP)，并发现患有SAD的年轻人对社会威胁刺激的P1幅度比 具有典型的发展控制，从而表明在注意力定向期间增强的神经处理 社会威胁，提供了一个假定的ABMT目标。我们的数据进一步表明，ABMT可以降低焦虑严重程度 (即，临床疗效信号)和P1波幅，以及这些临床和神经变化一起发生。 这些数据使我们能够提出确凿的功效R01以(1)重新演示目标参与， (2)重新论证ABMT对社交焦虑症状严重程度的影响，(3)论证目标效度， 以及(4)评估结果的维持情况。我们还将(5)作为主持人探索注意力控制 结果。我们将随机抽取260名(每个地点N=130名)10-14岁的青少年参加 对ABMT或中立控制任务(NCT)感到难过。我们假设注意力集中在社会威胁上， 在点探测任务中使用P1事件相关电位幅度进行测量，社交焦虑症状的严重程度将 与NCT组相比，ABMT组在治疗后和6个月随访时显著降低。我们 进一步的假设是，P1波幅将调节社交焦虑症状严重程度的降低。 该项目将为青少年SAD提供一个严格的、动力充足的ABMT机械测试。 支持性的发现将使我们能够在社区和实践中进行ABMT的有效性试验 设置。这些发现还将为注意力控制在与精确度相关的未来研究中的前景提供洞察 医学即将到来。

Project Summary This 2-site (Florida International University, Yale University) R01 project proposes to confirm attention bias modification treatment (ABMT) as an efficacious treatment for social anxiety disorder (SAD) in peripubertal youth ages 10 to 14 years, and examine the mechanisms of ABMT's clinical efficacy. SAD is prevalent, chronic, and impairing. Response rates to evidence-based treatments (EBTs) are markedly lower for SAD than other anxiety disorders, and limited insights exist about mechanisms of positive outcome for those youths who do respond to existing EBTs. Alternative treatment options are therefore critically needed, particularly for translational neuroscience approaches that arise from NIMH's experimental therapeutics approach. ABMT is such an approach, as it is grounded in cognitive neuroscience theory and methods to address perturbed attention that operates on extremely rapid time scales. In accordance with NIMH's experimental therapeutics approach, we collected data in our preliminary work that support ABMT's feasibility and acceptability, and identifies a putative target mechanism. We next collected data demonstrating an effect on the target (i.e., target engagement) and linking changes in the target to clinical improvements (i.e., target validation). Specifically, we collected data on targeted rapidly deployed processes in event related potentials (ERP), and found that youth with SAD show enhanced P1 amplitudes for socially threatening stimuli compared with typically developing controls, thereby indicating enhanced neural processing during attention orienting to social threat, providing a putative ABMT target. Our data further show ABMT to reduce both anxiety severity (i.e., signal of clinical efficacy) and P1 amplitudes, with these clinical and neural changes occurring together. These data position us to propose a confirmatory efficacy R01 to (1) re-demonstrate target engagement, (2) re-demonstrate the effects of ABMT on social anxiety symptom severity, (3) demonstrate target validation, and (4) evaluate the maintenance of outcomes. We also will (5) explore attention control as a moderator of outcomes. We will randomize 260 (N = 130 at each site) clinic referred youths ages 10-14 years who meet for SAD to either ABMT or a Neutral Control Task (NCT). We hypothesize that attention orienting to social threat, measured using P1 ERP amplitudes in the dot-probe task, and social anxiety symptom severity will be significantly lower at post-treatment and 6-month Follow-Up in the ABMT arm compared with the NCT arm. We further hypothesize that P1 amplitudes will mediate reductions in social anxiety symptom severity. This project will provide a rigorous, sufficiently powered mechanistic test of ABMT for SAD in youth. Supportive findings would position us to pursue an effectiveness trial of ABMT in community and practice settings. Findings will also provide insight on attention control's promise for future research relating to precision medicine approaches.