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Multi-level Mechanisms of Behavioral Activation Therapy for Adolescent Depression

青少年抑郁症行为激活疗法的多层次机制

基本信息

批准号：
10617351
负责人：
W. EDWARD CRAIGHEAD
金额：
$ 77.23万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-03 至 2027-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10617351
关键词：
Address Adolescence Adolescent Adolescent Development Age Amygdaloid structure Anterior Behavior Therapy Behavior assessment Behavioral Behavioral Mechanisms Biological Markers Chronic Clinical Comprehension Corpus striatum structure Cues Data Decision Making Detection Development Disease Dorsal Ecological momentary assessment Emotions Functional Magnetic Resonance Imaging Future Goals Grant Image Individual Insula of Reil Intervention Investigational Therapies Knowledge Link Major Depressive Disorder Measures Mediating Mediation Mental Depression Modeling Modification Monitor Motivation Participant Patients Pattern Population Prefrontal Cortex Protocols documentation Psychotherapy Public Health Research Domain Criteria Rest Rewards Risk Sampling Scanning Schedule Severities Symptoms Techniques Testing Therapeutic Effect Therapeutic Intervention Therapeutic Research Treatment Efficacy Ventral Striatum Waiting Lists avoidance behavior child depression contrast imaging depressive symptoms design disability effective therapy efficacious treatment functional MRI scan imaging study insight interest negative emotional state neural neural circuit neurobiological mechanism neuroimaging neuromechanism novel positive emotional state precision medicine response reward anticipation social targeted treatment therapy development treatment response

项目摘要

Project Summary/Abstract Major Depressive Disorder (MDD) is a devastating clinical disorder and the leading cause of disability worldwide. Adolescence is a key developmental period during which risk for the development of depression is greatest. Behavioral Activation (BA) psychotherapy has emerged as a first-line treatment for adolescent depression, yet the underlying neurobiological mechanisms that mediate treatment efficacy remain unclear. Understanding these target mechanisms is fundamental to developing novel adaptations of BA, augmenting other treatments with BA, and designing new interventions informed by greater comprehension of neural target mechanisms. In the current application, we seek to identify the neural mechanisms that mediate treatment response during BA therapy for adolescent depression. Critically, reductions in avoidance behavior and successful BA treatment may occur through manipulation of multiple neural targets operating on different timescales between and/or within individuals. In cross-sectional neuroimaging studies of adolescent depression, the most common markers are hypo-responding to reward cues in the ventral striatum (VS) and ventromedial prefrontal cortex (vmPFC) and hyper-responding to negative information in the amygdala and the salience network–comprising the anterior insula (aI) and dorsal anterior cingulate (dACC). These patterns of hypo- and hyper-responding regions may independently or jointly contribute to behavioral avoidance by the RDoC concepts of reduced motivation for rewards and threat avoidance, respectively. Consequently, a fuller understanding of target engagement for BA requires multiple assessments linking trajectories of behavioral and symptom change with trajectories of change in these neural circuits over the course of therapy as opposed to just pre/post comparisons. To address these concerns, we propose to acquire ecological momentary assessment (EMA) and longitudinal neuroimaging data in a sample of 96 depressed adolescents while they complete a 16-week course of BA therapy. Three task-based fMRI scans will occur at baseline and after sessions 7 and 16, and will include a set of paradigms focused on assessing behavioral avoidance for monetary and social rewards. In addition, two brief “behavioral-scheduling-in-scanner” sessions will occur at sessions 3 and 9 during which the patient and therapist will engage in a component of BA therapy while the patient undergoes an fMRI scan. This “behavioral-secheduling-in-scanner” protocol will allow us to better determine the ecological validity of task-based measures of target engagement during psychotherapy. Taken together, these data will enable understanding of the neural mechanisms through which BA reduces avoidance behavior and thereby treats depression, Further, these data will establish a platform for developing future modifications of BA techniques and/or novel treatments based on identifiable neural targets.

项目总结/文摘