Brain response associated with parent-based treatment for childhood anxiety disorders

与基于父母的儿童焦虑症治疗相关的大脑反应

基本信息

批准号：
10339319
负责人：
Dylan Grace Gee
金额：
$ 80.38万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10339319
关键词：
Absenteeism at work Address Aftercare Age Amygdaloid structure Anxiety Anxiety Disorders Behavior Brain Child Child Rearing Childhood Clinical Clinical Data Clinical Research Clinical Trials Cognitive Therapy Data Decision Making Dependence Diagnosis Distress Emotions Enrollment Evaluation Evidence based treatment Face Family Family Process Fright Functional Magnetic Resonance Imaging Generalized Anxiety Disorder Generations Hand Human Hyperactivity Impairment Intervention Link Medial Mediator of activation protein Medical Modification Morbidity - disease rate Mothers Neurobiology Parents Participant Pattern Prefrontal Cortex Process Psychopathology Public Health Randomized Randomized Clinical Trials Reporting Risk Sampling Scanning Schools Separation Anxiety Social Functioning Symptoms Testing Translating Treatment Efficacy acceptability and feasibility anxiety reduction anxiety symptoms anxious barrier to care base brain circuitry childhood anxiety cost design efficacy testing functional MRI scan informant innovation insight multimodality neural circuit novel offspring personalized medicine psychosocial reduce symptoms research and development response social anxiety standard of care treatment duration treatment response treatment strategy

项目摘要

Currently, 50% of children do not benefit from evidence-based treatments for childhood anxiety disorders. This R61/R33 application proposes to test whether a novel entirely parent-based psychosocial intervention for childhood anxiety disorders engages amygdala-medial prefrontal cortex (mPFC) neural circuitry in the child's brain, implicated in children's reliance on parents to reduce their amygdala reactivity and anxiety; and whether changes in the target circuitry after treatment are associated with reductions in child anxiety. The R61 study will randomly assign 90 children (ages 7-10yrs) with primary anxiety disorders to one of two interventions: 1) Supportive Parenting for Anxious Childhood Emotions (SPACE), a novel completely parent- based treatment with no direct child involvement, that reduces children's anxiety by reducing parents' accommodation of their child's symptoms; or 2) Parent Educational Support (PES), a credible comparator intervention that is also entirely parent-based and controls for treatment duration and parent-therapist contact, but does not include any active modification of parental behavior. Before and after treatment, functional magnetic resonance imaging (fMRI) will be used examine children's reliance on parents to engage the target circuitry by comparing children's amygdala reactivity and mPFC connectivity in the presence of their mother and in the absence of their mother. We expect SPACE to reduce child reliance on parental presence to reduce amygdala reactivity, significantly more than PES. If this hypothesis is supported the R33 will be performed. The R33 will randomly assign 136 children (7-10yrs) with primary anxiety disorders to one of two interventions: 1) Parents participate in SPACE; or 2) Children receive cognitive-behavioral therapy (CBT), a standard of care treatment of known efficacy. We will use before and after fMRI and multi-informant/multi-modal child anxiety evaluations. We expect SPACE to reduce child reliance on parental presence to reduce amygdala reactivity, significantly more than CBT; We expect target engagement in SPACE to be associated with child anxiety symptom reduction; We expect SPACE will be feasible to deliver and acceptable to children and parents. This study is innovative in several ways and has the potential for large clinical and scientific impact. It is the first study to examine the impact of a psychosocial intervention on the neural circuitry of children with anxiety disorders, and the first study to examine the effects of an exclusively parent-only intervention with no child-therapist contact, on child brain circuitry. It will provide insight into the neurobiology of children's dependence on attachment figures for anxiety reduction, a process that contributes to the impairment and costs associated with childhood anxiety disorders. As many children are unable or unwilling to participate in therapy, results supporting the promise of SPACE as an effective way to reduce childhood anxiety would help to address a common barrier to treatment. Promising results from this study would provide the basis for a larger scale R01 clinical trial, to investigate the efficacy of SPACE and mediators and moderators of its effects.

目前，50% 的儿童没有从针对儿童焦虑症的循证治疗中受益。该 R61/R33 申请旨在测试是否有一种新颖的完全基于家长的心理社会干预措施儿童焦虑症涉及儿童大脑中的杏仁核内侧前额叶皮层 (mPFC) 神经回路大脑，与儿童依赖父母来减少杏仁核反应和焦虑有关；以及是否治疗后目标回路的变化与儿童焦虑的减少有关。 R61 研究将 90 名患有原发性焦虑症的儿童（年龄 7-10 岁）随机分配到两个组中的一个干预措施： 1）《针对焦虑童年情绪的支持性养育》（SPACE），一本完全由家长撰写的小说无需儿童直接参与的治疗，通过减少父母的焦虑来减少儿童的焦虑适应孩子的症状；或 2) 家长教育支持 (PES)，一个可靠的比较器干预也完全基于家长，并控制治疗持续时间和家长与治疗师的接触，但不包括对父母行为的任何主动改变。治疗前、治疗后、功能将使用磁共振成像（fMRI）检查儿童对父母参与目标的依赖程度通过在母亲在场的情况下比较儿童的杏仁核反应性和 mPFC 连接性来研究电路并且在母亲不在的情况下。我们期望 SPACE 能够减少儿童对父母在场的依赖，从而减少杏仁核的反应性，明显高于PES。如果该假设得到支持，则将执行 R33。这 R33 将随机分配 136 名患有原发性焦虑症的儿童（7-10 岁）接受以下两种干预措施之一：1) 家长参与SPACE；或 2) 儿童接受认知行为治疗 (CBT)，这是一种护理标准治疗效果已知。我们将在功能磁共振成像和多信息/多模式儿童焦虑之前和之后使用评价。我们期望 SPACE 能够减少儿童对父母在场的依赖，从而减少杏仁核的反应性，显着高于 CBT；我们预计 SPACE 中的目标参与与儿童焦虑有关症状减轻；我们期望 SPACE 能够切实可行地交付并为儿童和家长所接受。这项研究在多个方面具有创新性，并具有产生巨大临床和科学影响的潜力。这是第一项研究心理社会干预对儿童神经回路的影响焦虑症，也是第一项研究仅由家长进行干预的影响的研究儿童治疗师接触，关于儿童大脑回路。它将提供对儿童神经生物学的深入了解依赖依恋对象来减少焦虑，这一过程会导致损害和与儿童焦虑症相关的费用。由于很多孩子无法或不愿意参与治疗，结果支持 SPACE 作为减少儿童焦虑的有效方法的承诺将有助于解决治疗的常见障碍。这项研究的有希望的结果将为更大规模的R01临床试验，以研究SPACE的功效及其作用的调节因子和调节因子。