fMRI of Emotional Reactivity Cognitive Regulation and CBT for Social Phobia

描述(申请人提供)：这项建议的总体目标是阐明社交恐惧症(SP)情绪反应和认知调节的神经基础，并确定与SP认知行为疗法(CBT)相关的治疗变化的神经机制。基础研究已经检测了健康对照组(HC)的情绪反应和认知调节，但这项研究还没有描绘出SP患者情绪调节的潜在机制。临床研究表明，CBT对许多SP患者是一种有效的治疗方法，但其变化机制和治疗反应的预测因素尚未得到很好的描述。为了整合基础和临床文献，我们使用了一个框架，根据腹侧情绪生成脑区和背侧情绪调节脑区之间的相互作用来看待情绪调节。在这一框架内，我们建议考察HC和患有全面性SP的参与者在CBT前后的情绪反应和认知调节。拟议的研究针对3个目标：目标1考察SP和HC的情绪反应和认知调节的神经基础。研究1检验假设，即SP个体对社交焦虑刺激的腹侧情绪产生脑区表现出比HC更大的反应，但对(非社交)一般焦虑或中性刺激的反应相似。研究1B测试了一种假设，即当被要求调节对社交焦虑刺激的反应时，SP个体在背部情绪调节脑区的反应会比HC小，但当被要求调节对一般焦虑刺激的反应时，SP个体的反应与HC相似。目的2通过对SP患者CBT治疗前后的检测，明确其变化机制。完成研究1A和1B的SP患者将接受4个月的CBT。在完成治疗或等待名单(SP)或匹配的时间间隔(HC)后，研究2A检验了假设，即SP CBT应答者在腹侧脑区对社交焦虑刺激的反应(A)比治疗前低，(B)在CBT后比SP无应答者低，(C)比SP等待名单对照组低。研究2B检验了这样的假设：CBT应答者对社交焦虑刺激(A)比治疗前表现出更大的反应，(B)在治疗后比SP非应答者表现出更大的反应，(C)比SP等待名单的控制者表现出更大的反应。对于研究2A和2B，我们预计在时间2的SP CBT应答者和HC将对社会和一般焦虑刺激表现出类似的反应。目的3评估CBT治疗反应的预测因素。研究3测试了这样的假设，即治疗前和治疗后较高的情绪反应性(情感易损性)和较少的认知调节(执行缺陷)将独立地预测SP患者在CBT后5个月和10个月的更差的临床结果。这一翻译研究计划的广泛、长期目标是促进理论和临床干预方面的进步，以改善SP患者的心理健康。

DESCRIPTION (provided by applicant): The overall goal of this proposal is to elucidate the neural bases of emotional reactivity and cognitive regulation in social phobia (SP), and to identify the neural mechanisms underlying therapeutic change associated with cognitive-behavioral therapy (CBT) for SP. Basic research has examined emotional reactivity and cognitive regulation in healthy controls (HC), but this research has not yet delineated the mechanisms underlying emotion regulation in individuals with SP. Clinical research has shown that CBT is an effective treatment for many individuals with SP, but mechanisms of change and predictors of therapeutic response are not yet well described. To integrate basic and clinical literatures, we use a framework that views emotion regulation in terms of interactions between ventral emotion-generative brain regions and dorsal emotion- regulatory brain regions. Within this framework, we propose to examine emotional reactivity and cognitive regulation in HC and in participants with generalized SP pre- and post-CBT. The proposed studies address 3 aims: Aim 1 examines the neural substrates of emotional reactivity and cognitive regulation in SP versus HC. Study 1A tests the hypothesis that SP individuals will show greater responses than HC in ventral emotion-generative brain regions to social anxiety stimuli, but comparable responses to (non-social) general anxiety or neutral stimuli. Study 1B tests the hypothesis that SP individuals will show lesser responses than HC in dorsal emotion-regulatory brain regions when asked to regulate responses to social anxiety stimuli, but comparable responses when asked to regulate responses to general anxiety stimuli. Aim 2 identifies mechanisms of change by examining SP patients pre- and post-CBT. SP patients who complete Studies 1A and 1B will undergo 4 months of CBT. Upon completion of treatment or waitlist (SP) or a matched time interval (HC), Study 2A tests the hypothesis that SP CBT responders will show lesser responses in ventral brain regions to social anxiety stimuli (a) than at pre-treatment, (b) than SP non-responders at post-CBT, and (c) than SP waitlist controls. Study 2B tests the hypothesis that CBT responders will show greater responses in dorsal brain regions to social anxiety stimuli (a) than at pre-treatment, (b) than SP non-responders at post- treatment, and (c) than SP waitlist controls. For both study 2A and 2B, we expect that SP CBT responders and HC at Time 2 will show comparable responses to social and general anxiety stimuli. Aim 3 assesses predictors of treatment responses to CBT. Study 3 tests the hypothesis that greater emotional reactivity (affective vulnerability) and lesser cognitive regulation (implementation deficit) pre- and post-treatment will independently predict worse clinical outcomes at 5 and 10 months post-CBT for individuals with SP. The broad, long-term objective of this translational research program is to contribute to advances in theory and clinical interventions that will improve psychological well-being in people suffering from SP.