Neural mediators of behavior therapy for anxiety

描述(由申请者提供)：焦虑症是一种普遍且代价高昂的疾病。社交焦虑症(SAD)是最常见的焦虑症之一，可导致严重的功能障碍。尽管焦虑障碍的行为治疗干预措施很普遍，包括SAD，但对焦虑行为治疗的神经媒介的研究还不够充分。在这里，我们建议进行一项研究，以阐明行为疗法对SAD的神经认知影响。其次，它将允许在神经水平上对两种不同类型的行为治疗进行比较。参与者将随机接受认知行为疗法(CBT)、等待名单对照(WL)或较新形式的行为疗法、接受和承诺疗法(ACT)。主要的比较将在CBT和WL之间进行。二次比较将在CBT和ACT之间进行。使用功能磁共振成像(FMRI)在12周的CBT/ACT或12周的等待名单控制期之前和之后对SAD患者进行扫描，同时他们完成了非临床样本中广泛使用的威胁处理任务(影响任务的语言处理，或L-PAT)，我们预计治疗后神经激活与等待名单控制期相比将发生几个变化。也就是说，我们预计治疗后杏仁核对负价脸的反应会减少。我们还预计治疗后前额叶激活的增加，特别是在右腹外侧前额叶皮质(RVLPFC)，这与负面情绪的处理有关。以前对非临床样本的研究表明，RVLPFC可能会抑制或抑制杏仁核对威胁的反应；因此，我们预测治疗将努力加强这一过程。我们希望看到治疗后这两个区域(杏仁核和RVLPFC)的功能连接有所不同，这样治疗后RVLPFC和杏仁核的激活将更加强烈地负相关。我们预测，治疗后症状改善的程度也将与上文概述的神经激活的预期变化相关。我们还提出了一些关于CBT和ACT之间的差异的探索性假设，这些差异可能出现在神经水平上。这项拟议的工作将是对行为疗法治疗焦虑的神经介体的首批调查之一，也将是第一项在神经水平上比较两种行为疗法的研究。这项工作将阐明焦虑症的特征，并提高对焦虑症常用治疗方法的理解。公共卫生相关性：这项拟议的工作将是对行为疗法治疗焦虑的神经介体的首批调查之一，也将是第一项在神经水平上比较两种行为疗法的研究。这项工作将阐明焦虑症的特征，并提高对焦虑症常用治疗方法的理解。

DESCRIPTION (provided by applicant): Anxiety disorders are widespread and costly. Social anxiety disorder (SAD) is one of the most common anxiety disorders, and can lead to significant functional impairment. Despite the prevalence of behavior therapy interventions for anxiety disorders, including SAD, the neural mediators of behavioral treatment for anxiety are understudied. Here, we propose research that will elucidate the neurocognitive effects of behavior therapy for SAD. Secondarily, it will allow for the comparison of two distinct types of behavior therapy on a neural level. Participants will be randomized to either cognitive-behavioral therapy (CBT), a wait-list control (WL), or a newer form of behavioral therapy, acceptance and commitment therapy (ACT). Primary comparisons will be between CBT and WL. Secondary comparisons will be between CBT and ACT. Using functional magnetic resonance imaging (fMRI) to scan clients with SAD before and after the 12- week CBT/ACT or a 12-week wait-list control period while they complete a threat processing task that has been used extensively with non-clinical samples (the Linguistic Processing of Affect Task, or L-PAT), we expect to see several changes in neural activations after treatment, relative to the wait list control period. Namely, we expect reductions in the amygdala response to negatively-valenced faces after treatment. We also expect a post-treatment increase in prefrontal activation, specifically in the right ventrolateral prefrontal cortex (RVLPFC), which is implicated in the processing of negative affect. Previous work with non-clinical samples has suggested that the RVLPFC may work to inhibit or dampen the amygdala response to threat; therefore, we predict that therapy will work to strengthen this process. We expect to see a post-treatment difference in the functional connectivity of those two regions (the amygdala and RVLPFC), such that activations in the RVLPFC and amygdala will be more strongly negatively correlated after treatment. We predict that the degree of symptom improvement after treatment will also correlate with the expected changes in neural activation, outlined above. We also present some exploratory hypotheses about differences between CBT and ACT that may emerge at a neural level. The proposed work will be one of the first investigations of the neural mediators of behavior therapy treatment for anxiety, and would also be the first study to compare two behavior therapy treatments on a neural level. This work will shed light on the characteristics of anxiety disorders and improve understanding of the treatments commonly used for anxiety. PUBLIC HEALTH RELEVANCE: The proposed work would be one of the first investigations of the neural mediators of behavior therapy treatment for anxiety, and would also be the first study to compare two behavior therapy treatments on a neural level. This work will shed light on the characteristics of anxiety disorders and improve understanding of the treatments commonly used for anxiety.