Targeting adolescent depression symptoms using network-based real-time fMRI neurofeedback and mindfulness meditation

使用基于网络的实时功能磁共振成像神经反馈和正念冥想针对青少年抑郁症状

• 批准号: 10581837
• 负责人: RANDY PATRICK AUERBACH
• 金额: $ 104.4万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-21 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10581837
• 关键词: Address; Adolescent; Adult; Affect; Aftercare; Age; Attention; Attenuated; Brain; Childhood; Clinical; Coupled; Diagnosis; Disease; Dose; Double-Blind Method; Ecological momentary assessment; Emergency Situation; Environment; Exhibits; Functional Magnetic Resonance Imaging; Health Benefit; Intervention; Interview; Magnetic Resonance Imaging; Maintenance; Major Depressive Disorder; Medial; Mental Depression; Mental Health; Mindfulness Training; Motivation; Network-based; Neuroanatomy; Onset of illness; Outcome; Patient Self-Report; Patients; Pattern; Perception; Persons; Phase; Precision Medicine Initiative; Prediction of Response to Therapy; Prefrontal Cortex; Questionnaires; Randomized; Randomized, Controlled Trials; Recurrence; Relapse; Research; Rest; Sampling; Schizophrenia; Self Efficacy; Surgeon; Symptoms; Techniques; Testing; Therapeutic; Thinking; Time; Training; Treatment Efficacy; United States; Visual; child depression; cingulate cortex; clinical care; depressive symptoms; emotional distress; experience; health organization; improved; inattention; innovation; instrument; mindfulness; mindfulness meditation; neural; neural circuit; neurofeedback; novel; perceived stress; primary outcome; randomized, clinical trials; reduce symptoms; rumination; secondary outcome; skills; standard care; suicidal risk; sustained attention; symptomatic improvement

PROJECT SUMMARY Adolescent major depressive disorder (MDD) is common and debilitating. Presently, gold-standard treatments are only effective for approximately half of patients, underscoring the need to develop novel interventions, particularly to target core underlying mechanisms and more effectively treat this recurrent disorder. Rumination, the tendency to perseverate about depressive symptoms, contributes to MDD onset and predicts treatment non-response and relapse. At the neural level, rumination is characterized by elevated functional connectivity within the default mode network (DMN), and prior research also has consistently demonstrated patterns of DMN hyperconnectivity in MDD. Interestingly, mindfulness meditation, which trains attentional focus to the present moment, reduces perseverative thinking, ruminative tendencies, and depression symptoms. Further, our research and others have shown that adolescents can apply mindfulness practices to decrease perceived stress, increase sustained attention, and suppress DMN activity. Although mindfulness has profound mental health benefits, for some, mindfulness alone may not be sufficient to mitigate ruminative tendencies during a depressive episode. That is, MDD symptoms, including reduced motivation, inattention, and lack of self-efficacy, may impede a patient’s progress in successfully acquiring and utilizing mindfulness strategies necessary to change perceptions about one’s environment and relationships. To directly address this challenge, we propose using real-time fMRI neurofeedback to enhance the acquisition and utilization of mindfulness skills to better target DMN hyperconnectivity, rumination, and depressive symptoms. We developed a novel, 15-minute mindfulness-based, real-time neurofeedback (mbNF) paradigm whereby people observe a visual display of their brain activity and practice mindfulness to volitionally reduce DMN activation. In the R61 phase, 90 adolescents (ages 13-18) diagnosed with MDD will complete a 45-minute mindfulness training outside the scanner. To test target engagement of reducing DMN hyperconnectivity and optimal dosing, adolescents will then be randomized to receive either a 15- or a 30-minute mbNF session (n=45/dose group). If we meet our Go criterion (i.e., significantly reducing DMN hyperconnectivity), we will then proceed to the R33 phase to investigate whether mindfulness with mbNF outperforms mindfulness only. Thus, a new sample of 120 depressed adolescents (ages 13-18) will participate in a double-blind randomized clinical trial and receive mindfulness with the optimal mbNF dose (i.e., per the R61) or mindfulness only (n=60/group). We will test–using clinician-administered instruments, self-reports, and ecological momentary assessment– whether compared to mindfulness only, mindfulness with mbNF contributes to a greater reduction in clinician assessed depression symptoms (primary outcome) as well as decreased rumination (secondary outcome) across the post-treatment, 1-month, and 3-month assessments. As a whole, mbNF is directly in line with precision medicine initiatives, and if successful, could revolutionize clinical care for depressed adolescents.

项目摘要 青少年重大抑郁症（MDD）很常见且令人衰弱。目前，金色标准的治疗方法 仅对大约一半的患者有效，强调需要开发新的干预措施， 特别是针对核心基础机制，并更有效地治疗这种复发性疾病。 反省，坚持抑郁符号的趋势，有助于MDD发作和 预测治疗无响应和缓解。在神经层面，反省的特征是升高 默认模式网络（DMN）内的功能连接性，并且先前的研究也始终如一 显示了MDD中DMN超连接性的模式。有趣的是，正念冥想，训练 注意力集中在当前时刻，减少毅力思维，反省倾向和沮丧 症状。此外，我们的研究和其他研究表明，青少年可以将正念实践应用于 尽管正念减轻了感知的压力，持续的注意力增加并抑制了DMN活性。 对于某些人来说，深刻的心理健康益处可能不足以减轻反刍 抑郁发作期间的趋势。也就是说，MDD症状，包括减少动机，注意力不集中和 缺乏自我效能感可能阻碍患者成功获取和使用正念的进步 改变对环境和关系的看法所需的策略。直接解决这个问题 挑战，我们建议使用实时fMRI神经反馈来增强对的获取和利用 正念技巧可以更好地靶向DMN的超连续性，反省和抑郁症状。 我们开发了一种基于15分钟的小说，基于正念的实时神经反馈（MBNF）范式 人们观察他们的大脑活动和练习正念以自愿减少 DMN激活。在R61阶段，诊断为MDD的90名青少年（13-18岁）将完成45分钟 扫描仪外的正念训练。测试降低DMN高度连接性和 然后，最佳剂量，然后将青少年随机分配以接收15分钟或30分钟的MBNF会话 （n = 45/剂量组）。如果我们符合我们的G​​O标准（即大大降低了DMN的超连接性），那么我们将 继续进行R33阶段，以调查MBNF的正念是否仅优于正念。那， 新的120个抑郁青少年（13-18岁）的样本将参与双盲随机临床 通过最佳MBNF剂量（即，根据R61）或仅正念（n = 60/组）试验并接受正念。 我们将测试 - 使用临床管理工具，自我报告和生态瞬时评估 - 是否仅与正念相比，MBNF的正念有助于更大的临床减少 评估抑郁症状（主要结果）以及反刍（次要结果） 在治疗后，1个月和3个月的评估中。总体而言，MBNF直接与 精确的医学计划，如果成功的话，可能会彻底改变青少年的临床护理。

项目成果

Mindfulness-based real-time fMRI neurofeedback: a randomized controlled trial to optimize dosing for depressed adolescents.

• DOI: 10.1186/s12888-023-05223-8
• 发表时间: 2023-10-17
• 期刊: BMC PSYCHIATRY
• 影响因子: 4.4
• 作者: Bloom, Paul A.;Pagliaccio, David;Zhang, Jiahe;Bauer, Clemens C. C.;Kyler, Mia;Greene, Keara D.;Treves, Isaac;Morfini, Francesca;Durham, Katherine;Cherner, Rachel;Bajwa, Zia;Wool, Emma;Olafsson, Valur;Lee, Ray F.;Bidmead, Fred;Cardona, Jonathan;Kirshenbaum, Jaclyn S.;Ghosh, Satrajit;Hinds, Oliver;Wighton, Paul;Galfalvy, Hanga;Simpson, H. Blair;Whitfield-Gabrieli, Susan;Auerbach, Randy P.
• 通讯作者: Auerbach, Randy P.