Gaze-contingent music reward therapy for social anxiety

社交焦虑障碍（SAD）是最常见的精神疾病之一， 患病率高、慢性化和损伤程度高。SAD需要新的治疗方法，因为目前的一线治疗方法 治疗，如认知行为疗法和血清素再摄取抑制剂，失败的一半患者。 注意力分配已经成为一个有希望的目标，因为在SAD中，它偏向于威胁，它可以 客观地评估和系统地修改。然而，先前关于注意力偏差修正的研究 平均只有很小的影响。我们的基于眼动追踪的凝视相关音乐奖励疗法（GC-MRT）目标 持续的注意力分配，并解决了先前注意力偏差修正疗法的局限性：它使用 16张相互竞争的威胁和非威胁面孔的照片蒙太奇的复杂刺激，促进转移到真实的生活中 situations.它通过使用眼动跟踪来检测视觉注意力，并在训练时直接训练持续注意力。 发生.它结合了患者选择的音乐，这增强了任务参与度。其总体影响 注意力分配似乎涉及两个过程：a）通过奖励来加强对非威胁面孔的注视 （音乐）; B）训练注意力远离威胁面孔。初步数据表明，GC-MRT有很大的影响， 注意力分配，这些变化部分介导症状改善的大作用。 R61阶段将通过测试延长的8周疗程是否 具有更大的效果比标准的4周课程，它将测试是否GC-MRT从事的目标， 注意力分配，通过眼睛注视威胁面部的停留时间相对于整体停留时间的百分比来测量。 脸上它还将使用fMRI来探索GC-MRT对注意力控制神经过程的影响， 奖励处理在R61中，40名SAD成人将随机接受两种剂量的GC-MRT。R61 进展标准将基于注意力分配的有临床意义的变化，如通过 相对于基线，在最后一次会话期间在威胁面上的平均%停留时间。R33阶段将在 随机对照试验GC-MRT是否能改善SAD患者的症状和生活质量， 注意力分配的变化预测SAD症状的变化。它还将探讨神经和 注意力控制和奖励处理的行为测量随着治疗而变化， 症状有所改善在R33中，80名SAD成人将随机接受GC-MRT， 除了非偶然的连续音乐之外，控制治疗是相同的（所有治疗都将获得相同数量的 基于R61剂量探索结果）。R33中的阳性结果将作为确证性 R 01随机对照试验，推进了这种新型短期低成本治疗的进一步发展， 焦虑，可以适应虚拟现实设备，具有广泛传播的潜力。阴性结果 将澄清GC-MRT中涉及的机制，并导致GC-MRT的重新制定， 与症状改善最相关的过程。

Social anxiety disorder (SAD) is one of the most common psychiatric disorders, with a 5-13% lifetime prevalence and high chronicity and impairment. New treatments are needed for SAD, because current first-line treatments, such as cognitive behavioral therapy and serotonin reuptake inhibitors, fail half of patients. Attention allocation has emerged as a promising target because in SAD it is biased toward threat, and it can be objectively assessed and modified systematically. Prior studies of attention bias modification, however, have averaged only small effects. Our eye-tracking-based gaze-contingent music reward therapy (GC-MRT) targets sustained attention allocation and addresses limitations of prior attention bias modification therapies: It uses complex stimuli of photo montages of 16 competing threat and non-threat faces that foster transfer to real life situations. It directly trains sustained attention by using eye tracking to detect visual attention and to train it as it occur. It incorporates music chosen by the patient, which enhances task engagement. Its overall effect on attention allocation appears to involve two processes: a) reinforcing gaze at non-threat faces with reward (music); b) training attention away from threat faces. Preliminary data suggest that GC-MRT has large effects on attention allocation and that these changes partially mediate large effects on symptomatic improvement. The R61 phase will optimize the dose of GC-MRT by testing whether an extended 8-week course of treatment has greater effects than the standard 4-week course, and it will test whether GC-MRT engages the target of attention allocation, measured by the % of eye gaze dwell time on threat faces relative to overall dwell time on faces. It will also use fMRI to explore the impact of GC-MRT on neural processes of attention control and reward processing. In the R61, 40 adults with SAD will be randomized to the two doses of GC-MRT. The R61 progression criterion will be based on a clinically meaningful change in attention allocation, as assessed by mean % dwell time on threat faces during the last session, relative to baseline. The R33 phase will test in a randomized controlled trial whether GC-MRT improves symptoms and quality of life in persons with SAD, and if change in attention allocation predicts change in SAD symptoms. It will also explore whether neural and behavioral measures of attentional control and reward processing change with treatment and are associated with symptomatic improvement. In the R33, 80 adults with SAD will be randomized to GC-MRT versus a control therapy that is identical except for non-contingent continuous music (all will get the same number of sessions, based on R61 dose-finding outcome). Positive findings in the R33 will be the basis for a confirmatory R01 randomized controlled trial, advancing further development of this novel brief low-cost treatment for social anxiety that could be adapted for virtual reality devices with potential for wide dissemination. Negative findings would clarify the mechanisms involved in GC-MRT and lead to reformulation of GC-MRT directed at the processes most relevant to symptomatic improvement.