Transdisciplinary Studies of CBT for Anxiety in Youth

作为对CIDAR RFA的响应，这项中心拨款建议研究200名患有焦虑症(分离焦虑症、广泛性焦虑症和/或社交恐惧症)的青年(9-13岁)治疗反应的神经行为和社会相关性。所有青少年都将接受为期10周的CBT，以治疗儿童焦虑症，其中一半还将接受多成分干预，以改善睡眠。这些研究结合了情感神经科学的最新测量方法，自然环境中情绪、睡眠和行为的生态有效(EMA)测量，以及发展性框架治疗研究中的家庭和社会背景测量。这项研究设计的重点是治疗反应的预测因素和机制。该结构包括四个项目和三个核心。项目1：儿童和青少年焦虑症的认知和情感特征：从大脑机制到康复将测试“警觉-回避”模型的关键特征，重点是以下假设：治疗前情绪反应的神经关联将预测治疗反应，情绪处理的早期变化将与治疗期间的临床反应相关。项目2：睡眠增强对情感功能的影响为一半的青少年提供了一种多成分睡眠干预，以检验这样的假设：表现出睡眠改善的焦虑青少年将在焦虑和社会功能方面有更积极和持续的改善轨迹。项目3：青少年焦虑症CBT治疗反应的社会背景分析考察了家庭和社会背景中的情感经历如何与治疗反应和治疗过程中的变化相关联，以及这些如何与情感功能中的神经行为病毒变化相关联和相互作用。项目4：CBT治疗后焦虑及相关健康结果的调节者和中介者纵向检查焦虑和相关的健康结果(例如，抑郁和药物使用)，并检查过程与特定基因多态和环境应激源的关系。综上所述，这些研究将促进对神经行为、情感和社会过程的理解，这些过程支撑着治疗反应，为认知行为治疗的设计、改进和最佳发育时机提供信息，从而降低青少年这些常见疾病的发病率、死亡率和终生损害。

This center grant, in response to the CIDAR RFA, proposes to study neurobehavioral and social correlates of treatment response in 200 youth (ages 9-13) with anxiety disorders (separation anxiety, generalized anxiety disorder, and/or social phobia). All youth will receive 10 weeks of CBT for child anxiety disorders and half will also receive a multicomponent intervention to enhance sleep. The studies combines state-of-the-art measures from affective neuroscience, ecologically valid (EMA) measures of mood, sleep, and behavior in natural environments, and measures of family and social context within a developmental framed treatment study. The study design focuses on predictors and mechanisms of treatment response. The structure includes four projects and three cores. Project 1: Cognitive and Affective Features of Childhood and Adolescent Anxiety: From Brain Mechanisms to Recovery will test key features of a "vigilance-avoidance" model focusing on hypotheses that pre-treatment neural correlates of affective reactivity will predict treatment response and early changes in emotional processing will correlate with clinical response during treatment. Project 2: Effects of Sleep Enhancement on Affective Functioning provides a multicomponent sleep intervention to half of the youth to test hypotheses that anxious youth who show sleep improvements will have a more positive and sustained trajectory of improvements in anxiety and social function. Project 3: A Social Contextual Analysis of Treatment Response to CBT for Youth Anxiety examines how affective experiences within the family and social context are associated with treatment response and change across treatment, and how these are associated with and interact with neurobehaviroral changes in affective functioning. Project 4: Moderators and Mediators of Anxiety and Related Health Outcomes Following CBT Treatment examines anxiety and linked health outcomes (e.g. depression and substance use) longitudinally in anxious youth following treatment and examines the relationship of course to specific genetic polymorphisms and environmental stressors. Taken together these studies will advance understanding of the neurobehavioral, affective, and social processes that underpin treatment response in ways that will inform the design, refinement, and optimal developmental timing of cognitive behavioral treatments, and thus, decrease the morbidity, mortality, and lifetime impairments from these common disorders in youth.