Attention Training for Major Depressive Disorder

描述（由申请人提供）：重度抑郁症是一种常见的、反复发作的、损害性的疾病，预示着未来的自杀企图、人际关系问题、失业、药物滥用和犯罪。抑郁症的认知模型表明，对不安信息的偏颇处理有助于维持这种疾病。尽管抑郁症的认知理论得到了实证支持，但之前所有的研究都是相关的。这是一个主要的限制。如果不通过实验操纵注意力偏差，就不可能排除注意力偏差仅仅是重度抑郁症的一个后果，而在疾病的维持中没有因果作用。证明有偏见的注意力具有因果作用，将为维护MDD的过程提供重要的见解。我们提出的初步数据表明，注意力训练可以显著减少成年人的抑郁症状。在这项初步工作的基础上，我们现在建议调查是否改变负性偏见的注意力会减轻重度抑郁症患者的抑郁症状。目的1是确定在诊断为重度抑郁症的成年人中，改变对烦躁刺激的选择性注意是否比注意训练控制更能减轻抑郁症状。目的二是研究注意训练是否会改变参与情绪刺激注意加工的神经回路的功能。目的3是测试注意力训练是否能改善与抑郁维持有关的其他认知偏差，如持续处理烦躁刺激和增强对情绪刺激的回忆。这将是第一个确定负性偏向注意力是否在重度抑郁症成人患者的抑郁症状维持中起因果作用的研究。它还可以识别注意力训练后发生的神经和行为变化。这些发现可能会刺激治疗的发展，因为我们的项目将指出跨越行为（例如，负注意偏差）和神经（例如，改善PFC功能）水平的特定机制，这些机制可以维持重度抑郁症，并可以通过心理或药物干预特别针对。因此，提出的研究应该提高我们对重度抑郁症维持过程的认识，并为这一严重精神问题的治疗方案设计提供具体的指导。

DESCRIPTION (provided by applicant): Major depressive disorder is a common, recurrent, and impairing condition that predicts future suicide attempts, interpersonal problems, unemployment, substance abuse, and delinquency. Cognitive models of depression suggest that biased processing of dysphoric information contributes to the maintenance of the disorder. Despite empirical support for cognitive theories of depression, all previous research has been correlational. This is a major limitation. Without experimentally manipulating biased attention, it is impossible to rule out that attentional bias is simply a consequence of MDD and has no causal role in the maintenance of the disorder. Demonstrating that biased attention has a causal role would provide important insight into the processes that maintain MDD. We present preliminary data that attention training can significantly reduce depressive symptoms among adults. Building on this preliminary work, we are now proposing to investigate whether changing negatively biased attention reduces depressive symptoms among individuals diagnosed with Major Depressive Disorder. Aim 1 is to determine whether modifying selective attention for dysphoric stimuli reduces depression symptoms to a greater extent than an attention training control among adults diagnosed with MDD. Aim 2 is to investigate whether attention training alters the function of neural circuitry involved in attentional processing of emotion stimuli. Aim 3 is to test whether attention training improves other cognitive biases implicated in depression maintenance, such as sustained processing of dysphoric stimuli and enhanced recall of emotion stimuli. This would be the first study to determine whether negatively biased attention has a causal role in the maintenance of depression symptoms among adults with MDD. It would also identify neural and behavioral changes that occur following attention training. Such discoveries could spur treatment development, as our project would point to specific mechanisms across behavioral (i.e., negative attention bias) and neural (e.g., improved PFC function) levels that maintain MDD and could be specifically targeted by psychological or pharmacological interventions. Thus, the proposed study should advance our knowledge of the maintenance processes for MDD and provide specific direction for the design of treatment programs for this serious psychiatric problem. PUBLIC HEALTH RELEVANCE: The overarching goal of this project is to determine whether altering biased attention for dysphoric information leads to symptom improvement among adults diagnosed with Major Depressive Disorder (MDD). Determining whether negatively biased attention has a causal role in the maintenance of MDD would advance our knowledge of the maintenance processes for MDD and provide specific direction for the design of treatment programs for this serious psychiatric problem.