Gaze-contingent music reward therapy for social anxiety

社交焦虑症(SAD)是最常见的精神障碍之一，终生发病率为5%-13% 患病率和高度慢性化和损害。SAD需要新的治疗方法，因为目前的一线 认知行为疗法和5-羟色胺再摄取抑制剂等治疗方法失败了一半的患者。 注意力分配已经成为一个有希望的目标，因为在SAD中，注意力分配偏向于威胁，而且它可能是 客观系统地评估和修改。然而，先前对注意偏差修正的研究已经 平均只有很小的影响。我们基于眼球跟踪的视线条件音乐奖励疗法(GC-MRT)目标 持续的注意力分配和解决先前注意力偏向修正疗法的局限性：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，促进向现实生活的转移 情况。它直接训练持续的注意力，使用眼球跟踪来检测视觉注意力并将其训练为 发生。它结合了患者选择的音乐，从而增强了任务参与度。它的总体效果对 注意力分配似乎涉及两个过程：a)通过奖励加强对非威胁面孔的凝视 (音乐)；b)将注意力从威胁面孔上移开。初步数据显示，GC-MRT有很大的影响 在注意力分配上，这些变化部分地在症状改善上起到了很大作用。 R61阶段将通过测试延长的8周疗程是否能优化GC-MRT的剂量 比标准的四周课程有更大的效果，它将测试GC-MRT是否达到 注意力分配，由眼睛凝视威胁面孔的停留时间相对于总体停留时间的百分比来衡量 面孔。它还将使用fMRI来探索GC-MRT对注意控制和神经过程的影响。 奖励处理。在R61中，40名患有SAD的成年人将随机接受两种剂量的GC-MRT。R61 进展标准将基于临床上有意义的注意力分配变化，由 上一次会话期间威胁面上的平均停留时间(相对于基线)。R33阶段将在一个 GC-MRT是否改善SAD患者的症状和生活质量的随机对照试验 注意力分配的变化预示着SAD症状的变化。它还将探索神经性和 注意控制和奖赏加工的行为测量随着治疗的变化而变化，并且是相关的 症状有所改善。在R33中，80名患有SAD的成年人将随机接受GC-MRT治疗，而不是 控制疗法，除了非偶然的连续音乐外，是相同的(所有人将获得相同数量的 会议，基于R61剂量发现结果)。R33中的积极发现将成为确凿证据的基础 R01随机对照试验，推动这一新的简短、低成本的社会治疗方法的进一步开发 焦虑，可以被改编成具有广泛传播潜力的虚拟现实设备。负面调查结果 将澄清GC-MRT涉及的机制，并导致针对 与症状改善最相关的流程。

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.