Enhancing Anxiety Treatment with Strategies from Behavioral Neuroscience Research

描述(由申请者提供)：该项目的主要目标是确定行为神经科学研究中的两种恐惧缓解技术是否可以被转化为增加焦虑症的暴露疗法。具体地说，我们将测试恐惧恢复和复合消退的技术。之前进行了一次简短的恐惧恢复试验 灭绝通过重新巩固更新机制来增强恐惧的减少。在多个恐惧刺激同时面对的情况下，进行复合消退通过纠错机制增强恐惧的减少。研究1(类比研究)将测试恐惧再现和复合消退对加强暴露疗法治疗特定恐惧症的单一和交互作用。研究一采用2×2设计，将恐惧提取(是或否)和复合消退(是或否)作为两个被试之间的因素。有蜘蛛恐惧症或恐惧症的受试者(N=120)将被随机分成四组：(1)照常暴露(不增加)，(2)暴露与恐惧恢复，(3)暴露与复合消退，(4)暴露与恐惧恢复和复合消退。在治疗后和一周的随访中(对照基线恐惧水平)，将使用行为测量和自我报告测量来评估恐惧恢复和复合消退增强对恐惧的恢复和自发恢复的影响。研究2的目的是测试将研究1(恐惧恢复和/或复合消退)产生的最有效的治疗强化策略整合到创伤后应激障碍(PTSD)的长期暴露疗法(PE)中的可行性。为了提供比较PE和增强PE疗效的初步测试，我们将采用交替处理设计40，其中每个参与者都接受两种干预。参与者(N=5)将接受10次创伤后应激障碍暴露治疗，并将被随机分配到两种治疗条件(PE或增强PE)中的一种。创伤后应激障碍症状将在每周一次治疗开始时和最后一次治疗后一周进行评估。从给定疗程开始到一周后，创伤后应激障碍症状的变化将提供对每个疗程的有效性的评估。由于暴露疗法在焦虑症的大多数手动治疗中发挥着核心作用，这两项研究的结果可能会为开发更有效的全方位焦虑症暴露疗法提供信息。

DESCRIPTION (provided by applicant): The overarching objective of this project is to determine whether two fear attenuation techniques from behavioral neuroscience research can be translated to augment exposure therapy for anxiety disorders. Specifically, we will test the techniques of fear retrieval and compound extinction. Conducting a brief fear retrieval trial prior to extinction enhances fear reduction through the reconsolidation update mechanism. Conducting compound extinction, in which multiple feared stimuli are confronted simultaneously, enhances fear reduction through the error-correction mechanism. Study 1 (an analogue study) will test both the singular and interactive effects of fear retrieval and compound extinction for enhancing exposure therapy for specific phobia. Study 1 will use a 2 x 2 design, with fear retrieval (yes or no) and compound extinction (yes or no) as the two between-subjects factors. Participants (N=120) with arachnophobia or ophidiophobia will be randomized to one of four groups: (1) exposure as usual (no augmentation), (2) exposure with fear retrieval, (3) exposure with compound extinction, and (4) exposure with fear retrieval and compound extinction. Behavioral and self-report measures will be used to assess the impact of the fear retrieval and compound extinction augmentations on renewal and spontaneous recovery of fear at post-treatment and one-week follow- up (controlling for baseline fear level). The aim of study 2 is to test the feasibility of integrating the most effective treatment augmentation strategy that emerges from study 1 (fear retrieval and/or compound extinction) into prolonged exposure therapy (PE) for posttraumatic stress disorder (PTSD). To provide a preliminary test comparing the efficacy of PE with augmented PE, we will employ an alternating treatments design40 in which each participant receives both interventions. Participants (N=5) will receive 10 sessions of exposure therapy for PTSD, and will be randomized to one of the two treatment conditions (PE or augmented PE) for each session. PTSD symptoms will be assessed at the start of each, weekly session and one week after the last session. Change in PTSD symptoms from the start of a given session to one week later will provide an assessment of the effectiveness of each session of therapy. Since exposure therapy plays a central role in most manualized treatments for anxiety disorders, findings from these two studies could inform the development of more potent exposure therapies across the full spectrum of anxiety disorders.