Development of a novel exercise threat attentional bias assay

摘要 与年龄相关的心脏变化会增加心血管疾病的风险以及其他健康风险，如 虚弱、跌倒和痴呆症。运动有助于减缓心脏衰老相关变化的进展 是心脏康复(CR)的重要组成部分，CR是用于 从心脏事件或外科手术中快速恢复。然而，登记参加CR的大多数患者 只参加了一部分课程，大多数确实参加的人未能保持足够的体能水平 CR节目结束后的活动。焦虑是人类最早、最强烈的心理反应之一。 急性脑血管病。“运动焦虑”，即对身体活动的恐惧和回避--可能与 成功的CR。从认知-行为框架来看，心脏相关症状或并存的存在 疾病可以提高个人对身体感觉的意识，促进对健康的恐惧和担忧 安全，并导致运动回避。我们开发了一种手工化的、理论上知情的认知行为 旨在针对运动的被称为行为暴露的内感耐受(BE-FIT)的干预 CR患者的焦虑状态。完全授权的家长资助(R01AG070136-01A1)包括仔细检查 导致运动焦虑的认知、行为和生理机制 治疗目标。家长拨款中缺少对信息处理方面的缺陷的仔细检查，这些缺陷 反映对威胁的偏见，这是焦虑病理的核心特征，可以通过注意偏差(AB)进行评估 任务。关于AB to Threat的文献记载，与非焦虑的个体相比，焦虑的个体 在一系列焦虑症中表现出与威胁相关的注意偏差，有证据表明这些 偏见是对干预的反应。然而，目前还没有研究工作考虑AB如何与运动相关 威胁刺激会影响身体活动行为。我们建议AB朝向锻炼和医疗- 相关刺激与CR患者的上下文相关，并可能导致并维持运动焦虑， 这反过来又会削弱锻炼和体力活动的参与度。与NOT-OD-22-140一致，我们 计划开发和验证一种新的检测方法，以进一步评估我们目前的治疗机制 RCT，并评估这一机制是否与干预研究的主要效果(疗效)有关 行为启动和维持的过程。具体地说，我们建议开发一个修改的Stroop任务来 检查CR患者对运动威胁的基础注意偏差，检查其与验证的关系 自我报告对锻炼感觉和专注于心脏的焦虑的恐惧程度，并测试这些是否良好 作为干预的一种功能，威胁偏向有所改善。通过开发和管理一种新的改进的Stroop任务 为了检查威胁偏向，我们将能够说明威胁偏向是一种潜在的行动机制，可以帮助 为了更好地理解健身干预如何起作用(或不起作用)来改变锻炼和身体状况 CR中的活动行为。

ABSTRACT Age-related changes to the heart increase risk for cardiovascular disease as well as other health risks, such as frailty, falls, and dementia. Exercise helps to slow the progression of aging-associated changes to the heart and is an essential component cardiac rehabilitation (CR), which is a secondary prevention program used to speed recovery from cardiac events or surgical procedures. However, the majority of patients who enroll in CR only attend a portion of sessions and the majority that do attend fail to maintain sufficient levels of physical activity after the CR program. Anxiety is among the earliest and most intense psychological reactions following acute CVD. “Exercise anxiety”, i.e., fear and avoidance of physical activity – may be particularly relevant to successful CR. From a cognitive-behavioral framework, the presence of heart-related symptoms or comorbid conditions can heighten individuals’ awareness of bodily sensations, promote fear and worry about health and safety, and lead to exercise avoidance. We developed a manualized, theoretically-informed, cognitive-behavioral intervention called Behavioral Exposure For Interoceptive Tolerance (BE-FIT) designed to target exercise anxiety in CR patients. The fully powered parent grant (R01AG070136-01A1) includes careful examination of cognitive, behavioral and physiological mechanisms that contribute to exercise anxiety and serve as important treatment targets. Missing from the parent grant is a careful examination of deficits in information processing that reflect a bias toward threat, a core feature of anxiety pathology that can be assessed via attentional bias (AB) tasks. The literature on AB to threat has documented that anxious, compared to non-anxious, individuals exhibit threat related attentional biases across a range of anxiety disorders and there is evidence that these biases are responsive to intervention. However, relatively no work has considered how AB to exercise-related threat stimuli could influence physical activity behavior. We propose that AB towards exercise and medical- related stimuli is contextually relevant to patients in CR, and can contribute to and maintain exercise anxiety, which in turn, can undermine exercise and physical activity participation. Consistent with NOT-OD-22-140, we plan to develop and validate a new assay in order to further assessment treatment mechanism in our current RCT, and evaluate whether this mechanism is related to the intervention study’s main effect (efficacy) over the course of behavior initiation and maintenance. Specifically, we propose to develop a modified Stroop task to examine basal attentional bias to exercise threat in patients attending CR, examine its relations with validated self-report measures of fear about exercise sensations and heart-focused anxiety, and test well as whether these threat biases improve as a function of intervention. By developing and administering a novel modified Stroop task to examine threat bias, we will be able illuminate the threat bias as a potential mechanism of action that can help to better understand how the BE-FIT intervention works (or does not work) to change exercise and physical activity behavior in CR.