NEURAL SUBSTRATES OF COGNITIVE-BEHAVIORAL THERAPY FOR SOCIAL ANXIETY DISORDER

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 引言 本研究旨在研究认知行为疗法对被诊断为社交焦虑症的成年人情绪反应和调节的神经基础的影响。 具体目标 该建议的总体目标是阐明社交恐惧症(SP)情绪反应和认知调节的神经基础，并确定与认知行为疗法(CBT)相关的治疗变化的神经机制。基础研究已经检测了健康对照(HC)的情绪反应性和认知调节[10，11]，但这项研究还没有描绘出SP患者情绪调节的潜在机制。临床研究表明，CBT对许多SP患者是一种有效的治疗方法[12]，但改变的机制和治疗反应的预测因素尚未得到很好的描述。为了整合基础和临床文献，我们使用了一个翻译框架，该框架根据腹侧情绪生成脑区和背侧情绪调节脑区之间的相互作用来看待情绪调节。在这一框架内，我们建议研究情绪反应性和认知调节的神经基础在HC和患有全面性SP的参与者CBT前后。我们建议的研究针对3个目标：目标1检查SP与HC的情绪反应和认知调节的神经基础；目标2通过检查CBT前后SP参与者确定变化机制；Aim 3评估CBT的长期治疗反应的预测因素。这一翻译研究计划的广泛、长期目标是促进理论和临床干预方面的进步，以改善SP患者的心理健康。 方法和材料 我们打算评估120名成年人(21-55岁)。在这些人中，80人将符合DSM-IV[83]在第一时间对当前广泛性社交恐惧症(SP)的初步诊断标准。另外40名参与者将是在年龄、性别、教育程度、种族和利手方面与SP匹配的非精神健康对照组(HC)。这一样本量将提供足够的统计能力来检验(A)CBT前时间1的SP与HC(目标1)，(B)CBT前后通过受试者内部和受试者之间的影响的变化(目标2)，以及(C)CBT治疗的长期反应的预测因素(目标3)。所有参与者将接受诊断性访谈、行为评估、一系列问卷、计算机任务和功能磁共振任务，以评估焦虑、情绪反应和调节的各个方面。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Introduction This study is examining the effect of cognitive-behavioral therapy on the neural bases of emotional reactivity and regulation in adults diagnosed with social anxiety disorder. Specific Aims The overall goal of this proposal is to elucidate the neural bases of emotional reactivity and cognitive regulation in social phobia (SP), and to identify the neural mechanisms underlying therapeutic change associated with cognitive-behavioral therapy (CBT). Basic research has examined emotional reactivity and cognitive regulation in healthy controls (HC) [10, 11], but this research has not yet delineated the mechanisms underlying emotion regulation in individuals with SP. Clinical research has shown that CBT is an effective treatment for many individuals with SP [12], but mechanisms of change and predictors of therapeutic response have not yet been well described. To integrate basic and clinical literatures, we use a translational framework that views emotion regulation in terms of interactions between ventral emotion-generative brain regions and dorsal emotion-regulatory brain regions. Within this framework, we propose to examine the neural substrates of emotional reactivity and cognitive regulation in HC and in participants with generalized SP pre- and post-CBT. Our proposed studies address 3 aims: Aim 1 examines the neural substrates of emotional reactivity and cognitive regulation in SP versus HC; Aim 2 identifies mechanisms of change by examining SP participants pre- and post-CBT; Aim 3 assesses predictors of longer-term treatment responses to CBT. The broad, long-term objective of this translational research program is to contribute to advances in theory and clinical interventions that will improve the psychological health of individuals suffering from SP. Methods and Materials We intend to assess 120 adults (ages 21-55 years). Of these, 80 will meet DSM-IV [83] criteria for a primary diagnosis of current generalized social phobia (SP) at Time 1. The other 40 participants will be non-psychiatric healthy controls (HC) each matched to an SP on age, sex, education, ethnicity, and handedness. This sample size will provide sufficient statistical power to examine (a) SP vs. HC at pre-CBT Time 1 (Aim 1), (b) pre- to post-CBT changes via within- and between-subjects effects (Aim 2), and (c) predictors of longer-term response to CBT treatment (Aim 3). All participants will undergo diagnostic interviewing, behavioral assessment, a battery of questionnaires, computer task, and fMRI task to assess facets of anxiety, emotional reactivity and regulation.