fMRI of Emotional Reactivity, Cognitive Regulation, and CBT for Social Phobia

描述（申请人提供）：本提案的总体目标是阐明社交恐惧症（SP）中情绪反应和认知调节的神经基础，并确定SP认知行为治疗（CBT）相关治疗变化的神经机制。基础研究检查了健康对照（HC）的情绪反应和认知调节，临床研究表明，认知行为疗法对许多SP患者是一种有效的治疗方法，但其改变机制和治疗反应的预测因子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，认为情绪调节在腹侧情绪生成脑区和背侧情绪调节脑区之间的相互作用。在这个框架内，我们建议检查情绪反应和认知调节在HC和参与者与广义SP前和后CBT。拟议的研究解决3个目标：目标1检查SP与HC的情绪反应和认知调节的神经基质。研究1A测试的假设，SP个人将显示更大的反应比HC在腹侧情绪生成的大脑区域的社会焦虑刺激，但类似的反应（非社会）一般性焦虑或中性刺激。研究1B测试的假设，SP个人将显示较少的反应比HC在背侧情绪调节脑区时，要求调节反应的社会焦虑刺激，但可比的反应时，要求调节反应的一般性焦虑刺激。目的2通过检查SP患者在CBT前后的变化来确定机制。完成研究1A和1B的SP患者将接受4个月的CBT。在完成治疗或等待列表（SP）或匹配的时间间隔（HC）后，研究2A测试SP CBT应答者在腹侧脑区域中对社交焦虑刺激的反应将显示出（a）比治疗前、（B）比在CBT后的SP无应答者和（c）比SP等待列表对照更少的假设。研究2B检验了以下假设：CBT应答者在背侧脑区域中将显示出对社交焦虑刺激的更大的应答（a）比治疗前，（B）比治疗后的SP无应答者，和（c）比SP等待名单对照。对于研究2A和2B，我们预计SP CBT应答者和HC在时间2时对社交和一般焦虑刺激的反应相当。目的3评估CBT治疗反应的预测因素。研究3验证了一个假设，即更大的情绪反应（情感脆弱性）和较少的认知调节（实施缺陷）治疗前和治疗后将独立预测SP患者在CBT后5个月和10个月的更差临床结局。这个转化研究计划的长期目标是促进理论和临床干预措施的进步，这将改善心理健康，在患有SP的人身上。

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.