Novel neural circuit biomarkers of depression response to computer-augmented CBT

计算机增强 CBT 抑郁反应的新型神经回路生物标志物

基本信息

批准号：
10166929
负责人：
YVETTE I SHELINE
金额：
$ 55.06万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-06-05 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10166929
关键词：
Adult Algorithms Ambulatory Care Facilities American Amygdaloid structure Anterior Antidepressive Agents Biological Markers Brain Caring Clinical Clinical Management Clinical Trials Cognitive Cognitive Therapy Computer Models Computers Conflict (Psychology)Consumption Control Groups Coping Behavior Data Depressed mood Diagnosis Disease Dorsal Emotional FDA approved Future Hour Image Individual Inferior frontal gyrus Lateral Magnetic Resonance Imaging Major Depressive Disorder Measures Mental Depression National Institute of Mental Health Outcome Outpatients Participant Patients Pennsylvania Placebos Population Prefrontal Cortex Protocols documentation Psychological Tests Randomized Recovery Research Personnel Rest Risk Site-Directed Mutagenesis Structure Thick Thinking Time Training Treatment Efficacy Treatment outcome Universities University Hospitals Variant Waiting Lists Work active method base cingulate cortex clinical decision support computer program computerized cost cost effective effective therapy efficacy testing evidence base executive function functional MRI scan improved negative affect neural circuit novel novel marker programs recruit reduce symptoms rehearsal response skills training treatment effect treatment response

项目摘要

Every year more than 20% (55 million) of the adult American population suffers from major depression. (MDD). While effective treatments are available, depression remains under-diagnosed and under-treated, in part due to cost and availability of treatment. In the current application in response to NIMH NOT-14-007 we propose a clinical trial to study potential novel biomarkers of depression treatment response rather than to test efficacy of an efficient, cost-effective form of computer-augmented cognitive behavioral therapy (CCBT) which already has proven efficacy. We present pilot data supporting CBT-induced improvements in functional connectivity and task-induced activation in MDD. We also have found in previous work that this model of CCBT, known as Good Days Ahead (GDA), has efficacy for MDD that is not inferior to conventional individual CBT therapy across 8 and 16 weeks of treatment, despite reducing average therapist contact from 16 hours to less than 5 hours. We now propose that this new variation of cognitive therapy, which substitutes intensive, computer- administered skills training for hours of therapist contact, will engage the same brain targets we have previously seen with CBT. We hypothesize that it is rehearsal time during which an individual actively engages in corrective skills training that “mends” the brain connectivity and promotes recovery. We will recruit a total of 60 patients with MDD and 40 matched comparison healthy participants from the outpatient clinics of the Hospitals of the University of Pennsylvania. To take into account the impact of nonspecific factors, half of the MDD participants will be randomized to receive CCBT immediately after baseline assessments and half will first receive 8 weeks of Depression Care Management (DCM) (a clinically responsible alternative to a traditional wait-list control group that includes support and clinical management) before subsequently receiving CCBT. Aim 1: Compare baseline resting state functional connectivity and task-induced activity between MDD and controls. Aim 2: Assess CCBT treatment effects on resting state functional connectivity and task- induced activation in MDD comparing CCBT-treated participants to DCM –treated participants. Exploratory Aim: 1a:Predict the effects of baseline imaging measures on treatment outcomes; 1b: Predict the effects of baseline executive function on treatment outcomes.

每年，成年美国人口中有超过20％（5500万）患有严重抑郁症。（MDD）。尽管有有效的治疗方法，但抑郁症仍未诊断和治疗不足，部分原因是以成本和治疗的可用性。在当前申请中，根据NIMH NOT-14-007，我们提出了一个临床试验研究潜在的新型抑郁症治疗反应的生物标志物，而不是测试一种有效的，具有成本效益的计算机提取的认知行为疗法（CCBT）的形式已证明有效性。我们提供了支持CBT引起的功能连接改善的试点数据和任务诱导的MDD激活。我们在以前的工作中还发现，这种CCBT模型，称为未来的好日子（GDA），对MDD的易于不如常规的单个CBT治疗在8和16周的治疗中，舒斯特的平均治疗师接触从16小时减少到小于5 小时。我们现在建议，这种新的认知疗法变异替代了密集，计算机 - 管理数小时的治疗师联系的技能培训将使我们拥有的相同的大脑目标接触以前在CBT中看到。我们假设个人积极参与的是彩排时间在“修补”大脑连接性并促进恢复的矫正技能培训中。我们将总共招募 60例MDD患者和40例与来自该诊所的门诊诊所的健康参与者相匹配宾夕法尼亚大学的医院。要考虑到非特异性因素的影响，一半 MDD参与者将在基线评估后立即随机接收CCBT，一半将首先获得8周的抑郁症护理管理（DCM）（临床负责的替代方案随后收到之前，传统的等待名单对照组，包括支持和临床管理） CCBT。目标1：比较基线静止状态功能连接和MDD之间的任务诱导的活动和控件。目标2：评估CCBT治疗对静止状态功能连通性和任务的影响 - 将CCBT处理的参与者与DCM处理的参与者进行比较的MDD激活。探索目的：1A：预测基线成像测量对治疗结果的影响； 1B：预测基线执行功能对治疗结果的影响。