fMRI of Emotional Reactivity Cognitive Regulation and CBT for Social Phobia

描述（由申请人提供）：本研究的总体目标是阐明社交恐惧症患者情绪反应和认知调节的神经基础，并确定社交恐惧症患者认知行为疗法（CBT）治疗变化的神经机制。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，从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情绪调节。在这个框架内，我们建议检查HC和广泛性SP参与者在cbt前后的情绪反应和认知调节。提出的研究有三个目的：目的1研究SP与HC的情绪反应和认知调节的神经基质。研究1A验证了这样一个假设，即SP个体在腹侧情绪生成脑区对社交焦虑刺激的反应大于HC，但对（非社交）一般焦虑或中性刺激的反应与HC相当。研究1B验证了这样的假设：当被要求调节对社交焦虑刺激的反应时，SP个体在背侧情绪调节脑区表现出的反应要小于HC，但当被要求调节对一般焦虑刺激的反应时，SP个体的反应要小于HC。目的2通过检查SP患者在cbt前和cbt后，确定改变的机制。完成研究1A和1B的SP患者将接受4个月的CBT治疗。在完成治疗或等待名单（SP）或匹配的时间间隔（HC）后，研究2A验证了以下假设：SP CBT应答者在腹侧脑区对社交焦虑刺激的反应(a)比治疗前小，(b)比CBT后无应答者小，(c)比SP等待名单对照组小。研究2B验证了以下假设：CBT应答者在脑背区对社交焦虑刺激的反应(a)比治疗前大，(b)比治疗后无应答者大，(c)比治疗后无应答者大。在研究2A和2B中，我们期望SP CBT应答者和HC在时间2中将对社交和一般焦虑刺激表现出可比的反应。目的3评估CBT治疗反应的预测因素。研究3验证了一种假设，即更大的情绪反应（情感脆弱性）和更少的认知调节（执行缺陷）治疗前后将独立预测SP患者在cbt治疗后5个月和10个月的临床结果更差。这个转化研究项目的广泛、长期目标是促进理论和临床干预的进步，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.