fMRI of Emotion Regulation During RCT of CBT vs. MBSR for Social Anxiety Disorder

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DESCRIPTION (provided by applicant): Emotion dysregulation is thought to be a core mechanism underlying many Axis-I and Axis-II psychiatric disorders. In particular, emotion dysregulation is believed to play a crucial role in the anxiety and mood disorders. A growing body of empirical work is beginning to illuminate the neural correlates and behavioral sequelae of emotion dysregulation in individuals suffering from anxiety and mood disorders. However, little is known about how psychosocial treatments for anxiety and mood disorders impact emotion dysregulation. The proposed study will directly address this gap in our knowledge by examining how two psychosocial treatment modalities-Cognitive- Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR)-impact two specific forms of emotion regulation-cognitive regulation (CR) and attention regulation (AR). The clinical context for our proposed study is generalized Social Anxiety Disorder (SAD), a highly prevalent, persistent, and often debilitating psychiatric condition characterized by overwhelming fear and avoidance of social situations. Our proposed research addresses three major aims: Aim 1 examines the efficacy and neural bases of CR and AR in SAD versus HC. Aim 2 investigates the immediate and longer-term impact of CBT versus MBSR for SAD. Aim 3 examines changes in CR and AR and tests whether these changes mediate effects of CBT versus MBSR. Adult patients with SAD will be randomly assigned to CBT, MBSR, or WL and administered assessments (including clinical diagnostic interviews, psychiatric and individual difference questionnaires, and functional neuroimaging of emotional reactivity and emotion regulation during a social evaluation task) at baseline, immediately after treatment, and 6 months post-treatment completion. The broad, long-term objective of this translational research program is to further our understanding of basic emotion regulation mechanisms and to contribute to advances in clinical interventions that will improve the health of individuals suffering from Social Anxiety Disorder (SAD) as well as a range of other anxiety and mood disorders. PUBLIC HEALTH RELEVANCE: The goal of this proposal is to elucidate the efficacy and neural bases of two specific forms of emotion regulation-cognitive regulation and attention regulation-in the context of Social Anxiety Disorder. We propose to study how two different psychosocial treatments-Cognitive-Behavioral Therapy and Mindfulness-Based Stress Reduction-differentially impact emotion regulation in Social Anxiety Disorder. The long-term objective of this research is to understand how psychosocial interventions address emotion dysregulation difficulties that are core features of psychiatric disorders.