Optimizing Exercise for the Treatment of Anxiety

项目总结/摘要 焦虑症是损害性的，是最常见的精神疾病之一;然而，许多 受影响的个人得不到循证护理，也得不到循证护理。因此，非常需要发展 并优化额外的第一线，更容易获得的焦虑症干预措施。锻炼对身体有益 焦虑和身体健康，没有许多副作用，可及性问题，或药物费用， psychotherapy.然而，坚持锻炼建议的人很少，高强度的锻炼更是如此 运动（HIE）在焦虑症患者中的作用。这可能是由于高焦虑敏感性（AS），或害怕 焦虑相关的生理感觉，因为HIE可能会引起类似的感觉。然而，没有正式的 任何心理健康状况的最佳运动强度或滴定指南，目前仍不清楚 运动是否需要较慢的滴定以获得最佳耐受性和对焦虑的反应。 为了发展运动作为一种正式规定的干预焦虑症的方式， 提高参与和坚持，需要研究来指导运动处方的最佳滴定， 并建立有针对性的机制，以在实践中取得最佳成果。为了弥补这些差距， 本研究将检验运动滴定对AS/焦虑症状严重程度以及参与度的影响 和坚持。具体来说，90名患有原发性焦虑症和中度至高度AS的久坐不动的成年人将 随机分配至8周的1）低强度运动，或2）灵活滴定至HIE。设盲、验证 将在治疗期间以及1个月和3个月随访时评估临床医生评定和患者评定的结局。到 更好地了解什么机制影响决定行使在现实世界中，和新颖的这一点 研究和关键训练目标，是使用心率（HR）作为运动的客观机械目标 强度，通过神经经济学任务检查运动评估的变化，以及 生态瞬时评估（EMA），以测量运动对情绪的即时变化对 焦虑结果和依从性。其他培训目标将支持研究数据分析， 最先进的统计技术，如增长曲线建模和机器学习。 这项研究的科学目的映射到我的培训计划在三个主要领域：1）应用NIMH 实验治疗方法，整合客观靶点机制（HR）和跨诊断AS， 2)与人力资源部一起检查EMA数据，以确定办公室外参与和响应的真实的时间驱动因素 设置，和3）应用先进的计算精神病学技术的数据分析。相关培训目标 将使神经经济学人类决策模型整合到当前的研究中， 神经行动机制的培训，以支持未来的R级提案。最后，博士的指导。 西蒙（主要导师）、阿布兰特斯（共同导师）、格里姆彻、杰伊、拉斯卡和派恩（顾问）将推动我 走向一个独立的研究生涯，专注于优化心理健康的运动干预。

PROJECT SUMMARY/ABSTRACT Anxiety disorders are impairing and amongst the most common psychiatric conditions; yet, many impacted individuals do not receive or respond to evidence-based care. There is thus a great need to develop and optimize additional first-line, more accessible interventions for anxiety disorders. Exercise has benefits for anxiety and physical health, without many of the side effects, accessibility issues, or costs of medications or psychotherapy. However, adherence to exercise recommendations is low, and even worse for high intensity exercise (HIE) in individuals with anxiety disorders. This may be due to high anxiety sensitivity (AS), or fear of anxiety-related physiological sensations, as HIE may induce similar sensations. There are, however, no formal guidelines for optimal intensity or titration of exercise for any mental health condition, and it remains unclear whether exercise requires slower titration for optimal tolerability and response for anxiety. In order to develop exercise as a formally prescribed intervention for anxiety disorders in a way that enhances engagement and adherence, research is needed to guide optimal titration of exercise prescriptions, and to establish mechanisms that should be targeted to optimize outcomes in practice. Addressing these gaps, this study will examine the impact of exercise titration on AS/anxiety symptom severity as well as engagement and adherence. Specifically, 90 sedentary adults with a primary anxiety disorder and moderate to high AS will be randomized to either 8 weeks of 1) low intensity exercise, or 2) flexible titration to HIE. Blinded, validated clinician-rated and patient-rated outcomes will be assessed over treatment and at 1- and 3-month follow-up. To better understand what mechanisms influence decisions to exercise in the real-world, and novel to this research and key training goals, are the use of heart rate (HR) as an objective mechanistic target for exercise intensity, examining changes in valuation of exercise through a neuroeconomics task, and the integration of ecological momentary assessment (EMA) to measure effects of immediate changes in mood with exercise on anxiety outcomes and adherence. Additional training goals will support the analysis of study data with state-of- the-art advanced statistical techniques such as growth curve modelling and machine learning. The scientific aims of this study map onto my training plan in three primary areas: 1) applying an NIMH experimental therapeutics approach, integrating an objective target mechanism (HR) and transdiagnostic AS, 2) examining EMA data with HR to identify real time drivers of engagement and response outside the office setting, and 3) applying advanced computational psychiatry techniques to data analysis. Related training goals will enable integration of neuroeconomic human decision-making models into the current study and integral training in neural mechanisms of action to support future R-level proposals. Finally, mentorship from Drs. Simon (primary mentor), Abrantes (Co-mentor), and Glimcher, Jay, Laska, and Pine (advisors) will propel me toward an independent research career focused on optimizing exercise interventions for mental health.