Positive Emotional Processing: Exploring Novel Treatment Targets in Social Phobia

描述（由申请人提供）：目前的提案是NIMH独立之路奖（K99/R00），旨在加强和扩大候选人在焦虑症领域转化研究方面的专业知识。职业发展规划：具有较强的焦虑基础实验精神病理学和治疗效果研究背景。贯穿候选人研究的一个始终的主题是应用社会认知的基本概念和实验程序来研究假设的影响广泛性社交焦虑障碍（GSAD）个体对积极社会信息的加工和同化的因素。这些实验研究的目的是为解决难治性GSAD病例的治疗方法提供新的见解。他的长期职业目标是留在学术界，成为一名以治疗为导向的临床科学家，具备必要的技能，确保他成为跨学科研究团队的一名富有成效的成员。候选人认识到扩展其现有技能的重要性，特别是在信息处理和神经生物学方法来检查焦虑的基本机制和治疗反应方面。因此，职业发展计划将利用来自病理性焦虑和恐惧的认知情感（Nader Amir博士，圣地亚哥州立大学）和神经生物学基础（Murray Stein博士，加州大学圣地亚哥分校；Martin Paulus博士，加州大学圣地亚哥分校）前沿研究专家的跨站点指导。这些研究人员指导积极的转化临床研究项目，将为候选人提供丰富的实践训练，在正在进行的项目的背景下。候选人还将完成神经影像学、生物统计学和研究伦理行为方面的正式课程和密集研讨会。环境：圣地亚哥州立大学心理学系和加州大学圣地亚哥分校精神病学学系之间长期而成功的合作历史提供了强大而完善的制度基础设施，将促进拟议培训计划的成功执行。候选人将有独特的机会见证传统的心理学系与研究型精神病学学系的成功合并，这将为跨学科研究团队提供一个在体内发挥作用的机会。卓越的学术声誉，国际公认的领域领导者的指导和咨询，以及圣地亚哥州立大学和加州大学圣地亚哥分校的合作跨学科环境，共同创造了一个非常适合促进候选人职业发展和向独立过渡的培训环境。研究计划：GSAD是一种常见且使人衰弱的疾病，其特征是社会关系功能显著受损，整体生活质量下降（例如，Alden & Taylor, 2004,2010; Stein & Stein, 2008）。包括GSAD在内的焦虑障碍的当代治疗方法是基于基于恐惧的消退学习模型（见Craske et al., 2008; McNally, 2007）。因此，这些治疗方法已经从研究中删除，这些研究指向GSAD中涉及积极社会和情感信息处理的基本调节系统失调（见Kashdan， 2007年的综述）。事实上，尽管现有的治疗方法在减轻社交焦虑和回避症状方面有疗效（例如，Hofmann & Smits, 2008； Rodebaugh等人，2004;Stein & Stein, 2008），但许多GSAD患者仍有残余症状，并在治疗后继续经历积极社会功能领域的严重中断（Eng等人，2005）。鉴于积极的社会和情感体验一直被证明对心理和身体健康结果有有益的影响，这些缺陷是值得注意的（例如，Folkman & Moskowitz, 2000； Lyubomirsky等，2005）。相反，有限的社会联系和社会孤立与发病率和死亡风险增加有关（例如，Cacioppo等人，2003年；House等人，1988年），这使GSAD成为一个重大的公共卫生问题。因此，为了弥合社会认知和情感神经科学的基本发现与SAD现有治疗方法之间的差距，候选人提出了一系列旨在阐明GSAD异常积极情绪反应的认知，情感和神经生物学基础的研究。这些研究的目的是为开发旨在改变GSAD （R期）积极社会情绪加工缺陷的实验程序确定新的目标。这项研究的长期目标是开发干预措施，可以增强现有的治疗方法，以提高难治性GSAD患者的治疗反应和积极的社会功能。

DESCRIPTION (provided by applicant): The current proposal is for a NIMH Pathway to Independence Award (K99/R00) designed to strengthen and expand the candidate's expertise in translational research in the area of anxiety disorders. Career Development Plan: The candidate possesses a strong background in basic experimental psychopathology and treatment outcome research in anxiety. A consistent theme running throughout the candidate's research is the application of basic concepts and experimental procedures in social cognition to study the factors hypothesized to bias the processing and assimilation of positive social information in individuals with generalized social anxiety disorder (GSAD). The goal of these experimental studies is to provide novel insights into ways of addressing treatment refractory cases with GSAD. His long-term career objectives are to remain in academia as a treatment-oriented clinical scientist with the requisite skills that will ensure his success as a productive member of an interdisciplinary research team. The candidate recognizes the importance of expanding his existing skill set, particularly in information processing and neurobiological approaches to examine basic mechanisms and treatment response in anxiety. Accordingly, the career development plan will take advantage of cross-site mentorship from leading experts at the vanguard of research studying the cognitive-affective (Dr. Nader Amir, San Diego State University) and neurobiological bases of pathological anxiety and fear (Dr. Murray Stein, University of California, San Diego; Dr. Martin Paulus, UCSD). These researchers direct active programs of translational clinical research that will provide the candidate with rich hands-on training in the context of ongoing projects. The candidate will also complete formal coursework and intensive seminars in neuroimaging, biostatistics, and the ethical conduct of research. Environment: The long-standing and highly successful collaborative history between the SDSU Department of Psychology and UCSD Department of Psychiatry provides the strong and well-established institutional infrastructure that will promote the successful execution of the proposed training plan. The candidate will benefit from the unique opportunity to witness the successful merging of a traditional psychology department with a research-oriented psychiatry department, a context that will provide an in vivo opportunitiy to function as part of a trans-disciplinary research team. The exceptional academic reputation, available mentorship and consultation of internationally recognized leaders in the field, and collaborative interdisciplinary environment of SDSU and UCSD unite to create a training environment that is ideally suited to promote the candidate's career development and transition to independence. Research plan: GSAD is a common and debilitating condition, marked by significant impairments in social relationship functioning and an overall diminished quality of life (e.g., Alden & Taylor, 2004, 2010; Stein & Stein, 2008). Contemporary treatment approaches for anxiety disorders, including GSAD, are grounded in fear-based models of extinction learning (see Craske et al., 2008; McNally, 2007). As a result, these treatments have been removed from research pointing to a dysregulation of basic regulatory systems involved in the processing of positive social and emotional information in GSAD (see Kashdan, 2007 for a review). Indeed, despite the efficacy of existing treatments in reducing symptoms of social anxiety and avoidance (e.g., Hofmann & Smits, 2008; Rodebaugh et al., 2004; Stein & Stein, 2008), many individuals with GSAD remain residually symptomatic and continue to experience significant disruptions in domains of positive social functioning following treatment (Eng et al., 2005). These deficiencies are notable given that positive social and emotional experiences are consistently shown to have a beneficial impact on psychological and physical health outcomes (e.g., Folkman & Moskowitz, 2000; Lyubomirsky et al., 2005). In contrast, limited social ties and social isolation are associated with increased morbidity and risk of mortality (e.g., Cacioppo et al., 2003; House et al., 1988), which positions GSAD as a significant public health concern. Thus, to bridge the gap between basic findings in social cognition and affective neuroscience and existing treatments for SAD, the candidate proposes a series of studies designed to elucidate the cognitive, affective, and neurobiological substrates of aberrant positive emotional responsiveness in GSAD. The goal of these studies is to identify novel targets for the development of experimental procedures designed to modify deficits in positive social emotional processing in GSAD (R phase). The long-term goal of this research is to develop interventions that can augment existing treatment approaches in the service of enhancing treatment response and positive social functioning in refractory GSAD patients. PUBLIC HEALTH RELEVANCE: Social anxiety disorder (SAD) is a common and debilitating condition, marked by significant impairments in social functioning and an overall diminished quality of life. Although existing treatments are efficacious in reducing symptoms of social anxiety and avoidance, individuals with SAD continue to report significant disruptions in social relationship functioning following treatment. Thus, the current proposal aims to address these issues by evaluating the effects of experimental procedures designed to enhance positive social and emotional functioning in SAD.