Reward System Recovery Following Behavioral Activation Therapy in Depression

描述（由申请人提供）：拟议研究的目的是使用功能磁共振成像（fMRI）检查重度抑郁症患者抑郁症状减轻的神经相关性。具体来说，我们建议在8至15周的抑郁症简短行为激活治疗疗程之前和之后两个时间点获取重度抑郁症患者的功能成像数据，这是一种结构化且经过良好验证的认知行为治疗方法，旨在降低对损失的敏感性，增强对奖励的敏感性（Hopko等人，2003a）。成像数据将集中在使用幸运之轮任务预期奖励时，由眶额皮质和前额皮质、前扣带，特别是腹侧纹状体组成的奖励网络的激活上（Ernst et al., 2004）。这个先前被验证的任务被设计成引起对奖励期望的反应，并且在非临床样本中被证明可以激活对奖励期望的反应的奖励网络（Ernst et al., 2005; Ernst et al., 2004）。这个奖励网络，尤其是腹侧纹状体，对于处理奖励预期和激励动机的线索至关重要（例如，Keedwell等人，2005）。在认知行为治疗后，奖励网络中对奖励预期的神经激活的增加将被评估与许多领域的症状减轻有关，最明显的是快乐丧失的症状（即快感缺乏）。这项被提议的研究有可能通过确定治疗的哪些组成部分影响对奖励的预期（这种精神疾病的中心缺陷），来磨练对重度抑郁症的心理干预目标。这项研究对公众健康的好处是更好地理解一种特殊形式的心理治疗是如何治疗抑郁症的。对抑郁症特定治疗有效性的大脑标记物的识别，将使未来的研究能够评估一系列治疗方法，所有这些治疗方法都有不同的成本和副作用，从而确定对重度抑郁症患者的最佳治疗方法。这样的策略与NIMH减轻精神疾病负担的使命是一致的。

DESCRIPTION (provided by applicant): The goal of the proposed research is to examine the neural correlates of depressive symptom reduction in individuals with major depressive disorder using functional magnetic resonance imaging (fMRI). Specifically, we propose to acquire functional imaging data from individuals with major depressive disorder at two points in time, both before and after an 8- to 15-week course of Brief Behavioral Activation Treatment for Depression, a structured and well-validated method of cognitive behavioral therapy designed to reduce sensitivity to loss and enhance sensitivity to reward (Hopko et al., 2003a). Imaging data will focus on activation of a reward network comprising the orbitofrontal and prefrontal cortices, the anterior cingulate, and, in particular, the ventral striatum, during anticipation of reward using the Wheel of Fortune Task, (Ernst et al., 2004). This previously validated task was designed to elicit responding to reward expectation and has been shown to activate this reward network in response to reward expectations in nonclinical samples (Ernst et al., 2005; Ernst et al., 2004). This reward network and the ventral striatum in particular, are critical for processing reward anticipation and cues of incentive motivation (e.g., Keedwell et al., 2005). Increased neural activation in this reward network in response to anticipation of reward after cognitive behavioral therapy will be evaluated in relation to symptom reduction in a number of domains, most notably symptoms of loss of pleasure (i.e., anhedonia). The proposed study has the potential to hone the targets of psychological interventions for major depressive disorder by identifying which components of therapy effect the anticipation of rewards, a central deficit in this psychiatric condition. The benefit to public health provided by this study would be a better understanding of how a specific form of psychotherapy may work to treat depression. The identification of brain markers of the effectiveness of a specific treatment for depression would enable future studies to evaluate a range of treatments, all with various costs and side-effect profiles, to determine optimum treatments for individuals suffering from major depressive disorder. Such a strategy is consistent with NIMH's mission to reduce the burden of psychiatric disorders.