Targeted Intervention for Adolescents following Child Maltreatment: Examining Neural and Behavioral Mechanisms within the Positive Valence System

项目摘要 全国数据显示，超过65万名儿童和青少年受到身体、性或 情感虐待或身体或情感忽视。此外，有童年经历的青年 虐待（CM）的人患抑郁症的可能性至少是其他人的两倍， 对当前最佳实践抑郁干预的响应（即，认知行为疗法和 抗抑郁药）与非虐待同龄人相比。研究表明，CM会增加患抑郁症的风险 通过破坏正价系统，如奖励处理和行为激活（BA） 可能是一种针对这些缺陷的替代抑郁干预措施。这一建议采取了创新的 一种整合神经、行为和新型移动的技术的方法， 奖励加工作为BA干预反应机制在有抑郁史青少年中的应用 的CM。这个建议的K23桥梁候选人的事先培训，在环境，生物和情感 病因学过程有助于青少年抑郁症与新的培训1）目标集中的干预 研究，2）发展情感神经科学，和3）基于技术的评估工具。本次培训 将独特地定位候选人，以研究多个水平的干预反应的生物标志物， 分析，重点是易受影响的青年，因为他们可能对干预措施不作出反应。特别是抑郁症 有CM病史的青少年将完成BA干预前后的fMRI和行为测量， 奖励处理沿着日常被动的移动的身体（步数）和社交（文本量， 电话，社交媒体使用）活动，以确定1）BA如何靶向神经和行为奖励处理 和现实世界的行为参与（具体目标1），以及2）是否改变神经和行为 奖励处理预测干预反应和维持（具体目标2）。 为了实现这些研究和培训目标，候选人将接受来自理想的培训 在最佳科学培训环境中的指导团队。麦考利博士是病因学专家， 治疗青少年抑郁症，并制定了一个BA协议，旨在增加奖励 经验和减少回避具体到青少年。McLaughlin博士在以下方面拥有丰富的专业知识： 发展情感神经科学和使用功能磁共振成像方法来研究神经回路相关的 受虐待青年的情感和奖励加工。Areán博士提供了额外的 专业知识，在目标为重点的抑郁症干预研究以及广泛的经验，在使用 移动的技术来评估实时行为、影响和心理健康。培训和研究活动 将准备候选人实现职业目标，发展更大的研究计划 通过研究以下创新生物标志物，为NIMH战略研究重点的目标3做出贡献： 在这方面，我们将继续努力采取干预应对措施，努力调整干预措施，优化弱势群体的成果。

PROJECT SUMMARY National data indicate over 650,000 children and adolescents are exposed to physical, sexual, or emotional abuse or physical or emotional neglect each year. Moreover, youth with a history of childhood maltreatment (CM) are at least twice as likely to develop depression and are at substantial risk for non- response to current best practice depression interventions (i.e., cognitive behavioral therapy and antidepressants) compared to non-maltreated peers. Research suggests that CM increases risk for depression through disruptions in the positive valence system, such as reward processing, and Behavioral Activation (BA) may be an alternative depression intervention that targets these deficits. This proposal takes an innovative approach integrating neural, behavioral, and novel mobile technologies to measure longitudinal change in reward processing as a mechanism of BA intervention response among depressed adolescents with a history of CM. This proposed K23 bridges the candidate's prior training in environmental, biological, and affective etiological processes contributing to adolescent depression with new training in 1) target-focused intervention research, 2) developmental affective neuroscience, and 3) technology-based assessment tools. This training will uniquely position the candidate to investigate biomarkers of intervention response across multiple levels of analysis, with an emphasis on vulnerable youth at risk for intervention non-response. Specifically, depressed adolescents with a history of CM will complete pre- and post- BA intervention fMRI and behavioral measures of reward processing along with daily passive mobile monitoring of physical (steps) and social (amount of texts, calls, social media usage) activity to determine 1) how BA targets neural and behavioral reward processing and real-world behavioral engagement (Specific Aim 1), and 2) whether change in neural and behavioral reward processing predicts intervention response and maintenance (Specific Aim 2). To achieve these research and training goals, the candidate will receive training from an ideal mentorship team within an optimal scientific training environment. Dr. McCauley is an expert in the etiology and treatment of adolescent depression and developed a BA protocol targeting the increase of rewarding experiences and decrease of avoidance specific to adolescents. Dr. McLaughlin has significant expertise in developmental affective neuroscience and the use of fMRI methodology to study neural circuitry related to affective and reward processing among youth exposed to maltreatment. Dr. Areán provides additional expertise in target-focused depression intervention research as well as extensive experience in the use of mobile technologies to assess real-time behavior, affect, and mental health. Training and research activities will prepare the candidate to achieve the career objective of developing a larger program of research contributing to Objective 3 of NIMH Strategic Research Priorities by investigating innovative biomarkers of intervention response in an effort to tailor interventions and optimize outcomes in vulnerable populations.