Modification of Threat Interpretation Bias to Reduce Anxiety in Neurodegenerative Movement Disorders

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PROJECT SUMMARY: The proposed K23 award will prepare Dr. Jessie Gibson, PhD, RN, AGPCNP-BC to become an independent investigator developing interventions for neuropsychiatric symptom management in neurodegenerative disease. Dr. Gibson’s clinical and research experiences have provided a foundation in identification, measurement, and effects of neuropsychiatric symptoms in Huntington’s disease (HD) and Parkinson’s disease (PD). The proposed research plan will prepare Dr. Gibson to take the next steps toward investigating treatment for these symptoms in independent clinical trials. Anxiety symptoms are extremely prevalent in HD and PD, causing significant burden for patients and caregivers. Unfortunately, there is limited evidence for how to treat these symptoms. Experts recommend use of psychological interventions to treat anxiety symptoms in HD and PD, but there have been few rigorous studies to support these recommendations. Cognitive bias modification for interpretation bias (CBM-I) paradigms address negative interpretation biases by training participants to (re)interpret ambiguous, potentially threatening situations in more benign ways to make anxious thinking more flexible. Our preliminary work has demonstrated feasibility of web-based CBM-I in this population and identified the need to adapt CBM-I programs to meet the needs of individuals with movement disorders. Our current objective is to determine whether a web-based cognitive bias modification for interpretation bias (CBM-I) intervention can reduce anxiety in PD and HD. Thus, we aim to: 1) gather stakeholder perspectives and 2) develop a web-based CBM-I intervention tailored to individuals with neurodegenerative movement disorders (MindTrails-Movement), then 3) evaluate target engagement and preliminary efficacy of MindTrails-Movement for reducing interpretation bias and anxiety symptoms in HD and PD. To carry out these aims and prepare Dr. Gibson to become a national leader in developing interventions for neuropsychiatric symptom management in neurodegenerative disease, she will work with an expert mentoring team led by Dr. Bethany Teachman, and including co-mentors Drs. Madaline Harrison, Carol Manning, Jeanne Alhusen, and Guofen Yan. Training experiences will support Dr. Gibson’s career development goals to: 1) cultivate skills to develop behavioral interventions using human-centered design; 2) develop expertise in clinical trial design and implementation; 3) establish advanced knowledge of mechanisms that maintain mood and anxiety disorders; and 4) develop leadership and grantsmanship skills and establish collaborations to prepare for a successful career as an independent nurse scientist. University of Virginia provides the ideal environment to achieve these research and career development goals, as home to a world- class nursing school, Huntington’s Disease Center of Excellence, American Parkinson’s Disease Association Advanced Center for Research, and the Program for Anxiety, Cognition and Treatment (PACT) lab- all of which are critical to the success of this proposal.