Attention Training for Major Depressive Disorder

描述(由申请人提供)：重度抑郁障碍是一种常见的、反复出现的、损害健康的疾病，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，对烦躁不安信息的有偏见的处理有助于维持这种障碍。尽管抑郁症的认知理论得到了经验上的支持，但之前的所有研究都是相互关联的。这是一个主要的限制。如果没有实验地操纵有偏见的注意，就不可能排除注意偏见只是MDD的结果，在这种障碍的维持中没有因果作用。证明有偏见的关注具有因果作用，将为维持MDD的过程提供重要的洞察力。我们提供的初步数据表明，注意力训练可以显著减少成年人的抑郁症状。在这项前期工作的基础上，我们现在提议调查改变消极偏见的注意力是否会减少被诊断为严重抑郁障碍的个体的抑郁症状。目的1是确定在被诊断为MDD的成年人中，对烦躁刺激修改选择性注意是否比注意力训练控制更大程度地减少抑郁症状。目的二是研究注意训练是否改变了情绪刺激注意加工过程中神经回路的功能。目标3是测试注意力训练是否改善了其他与抑郁维持有关的认知偏差，如持续处理烦躁的刺激和增强对情绪刺激的回忆。这将是第一个确定消极偏见的注意力是否在成年MDD患者抑郁症状的维持中起因果作用的研究。它还将确定注意力训练后发生的神经和行为变化。这样的发现可能会刺激治疗的发展，因为我们的项目将指出维持MDD的行为(即负面注意偏差)和神经(例如，改善的PFC功能)水平的特定机制，并可能成为心理或药物干预的特定靶点。因此，拟议的研究应该促进我们对MDD维持过程的了解，并为这一严重精神问题的治疗方案的设计提供具体的指导。 公共卫生相关性：该项目的首要目标是确定改变对烦躁不安信息的有偏见的关注是否会导致诊断为严重抑郁障碍(MDD)的成年人的症状改善。确定消极偏向的注意是否在MDD的维持中起因果作用，将促进我们对MDD维持过程的了解，并为设计针对这一严重精神问题的治疗方案提供具体指导。

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.