A randomized controlled trial examining the impact of a brief attention-based neurobehavioral transdiagnostic intervention on acute fear response

一项随机对照试验，研究基于短暂注意力的神经行为跨诊断干预对急性恐惧反应的影响

• 批准号: 10291622
• 负责人: HOLLY K ORCUTT
• 金额: $ 42.62万
• 依托单位: NORTHERN ILLINOIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10291622
• 关键词: Acute; Amygdaloid structure; Anterior; Anxiety; Anxiety Disorders; Area; Attention; Attentional deficit; Behavioral; Biological; Biological Markers; Blinking; Brain; Brain region; Categories; Conditioned Stimulus; Data; Data Reporting; Development; Diagnosis; Diagnostic; Dimensions; Disease; Dorsal; Down-Regulation; Effectiveness; Exhibits; Fright; Functional disorder; Genetic Markers; Impairment; Individual; Intervention; Learning; Link; Maintenance; Measures; Mental Depression; Mental disorders; Modernization; Neurobiology; Neurologic; Panic; Panic Disorder; Pathologic; Patient Self-Report; Patients; Phenotype; Phobias; Physiology; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Proxy; Psychopathology; Psychotherapy; Randomized Clinical Trials; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Domain Criteria; Risk Factors; Sampling; Self Administration; Short-Term Memory; Source; Specific Phobia; Startle Reaction; Stimulus; Symptoms; System; Testing; Training Technics; Trauma; attentional control; base; behavior measurement; cingulate cortex; cognitive function; conditioned fear; design; effective therapy; endophenotype; executive function; experience; improved; neurobehavioral; neuroimaging; novel; post intervention; post-traumatic symptoms; psychologic; public health relevance; reduce symptoms; response; smartphone Application; social anxiety; theories; therapy design; treatment group; treatment response; undergraduate student

Project Summary/Abstract Despite decades of research, current psychological treatments designed to treat a variety of mental illnesses are not effective for all who receive them. Specifically, well-supported treatments for mental illnesses that involve fear (e.g., PTSD, panic) appear to be effective for the majority of individuals, but consistently leave a group of “treatment non-responders.” One potential explanation for the observed discrepancy in treatment response may be the focus of modern psychotherapies on relieving symptoms specific to categorical diagnoses, rather than mechanisms underlying why the individual is experiencing the symptoms. Recently, fear-based psychological disorders (e.g., PTSD, specific phobia, panic disorder, social anxiety) have been identified as sharing a distinct set of biomarkers, including genetic biomarkers of acute fear (i.e., fear in the moment) and impairments in controlling attention. Neurobehavioral interventions are therefore a promising class of treatments designed to target the biological markers that may be maintaining the symptoms of various psychological disorders. The Attention Training Technique (ATT) is a neurobehavioral intervention that has garnered attention through its demonstrated effectiveness in reducing symptoms across a variety of psychological diagnoses. While grounded in well-established theory, the mechanisms of change in ATT are largely unknown. One proposed mechanism may be that ATT promotes functional connectivity between regions in the brain implicated in top-down executive control over attention (ventromedial prefrontal cortex [vmPFC] and dorsolateral prefrontal cortex [dlPFC]) and bottom-up attention networks (dorsal anterior cingulate cortex [dACC] and amygdala), resulting in increased top-down regulation of potentially problematic bottom-up attentional processes. The same brain regions implicated in both top-down and bottom-up attentional processes have also been associated with fear responding (i.e., startle response) and fear learning (i.e., how quickly one learns that a stimuli is safe or to be feared). Taken together, the research suggests that acute fear responding may be decreased through increased executive control over attention through engagement in ATT. The proposed randomized clinical trial will test whether a self-administered brief neurobiological intervention (ATT) to increase attentional control will decrease acute fear responding, and whether this change is associated with normative dACC functioning, measured by behavioral proxy. It is expected that those who engage in ATT will show greater attentional control efficiency, which will decrease their acute fear response. It is also expected that those who engage in ATT will also show greater dACC functioning, measured by behavioral proxy and will exhibit decreases in their reported fear as their attentional control increases over the course of the intervention. Additionally, it is expected that the intervention (ATT) will indirectly decrease symptoms of categorical fear-based psychological diagnoses through the identified biomarkers (i.e., attentional control, dACC functioning, acute fear response) to decrease reported symptoms.

项目概要/摘要 尽管经过了数十年的研究，当前的心理治疗旨在治疗各种精神疾病 并不是对所有接受治疗的人都有效，特别是对精神疾病的有效治疗。 涉及恐惧（例如创伤后应激障碍（PTSD）、恐慌）似乎对大多数人有效，但始终留下一个 一组“治疗无反应者”。对观察到的治疗差异的一个可能解释 反应可能是现代心理治疗的重点，旨在缓解特定的症状 诊断，而不是个人出现症状的机制。 基于恐惧的心理障碍（例如创伤后应激障碍（PTSD）、特定恐惧症、恐慌症、社交焦虑症） 被确定为共享一组独特的生物标志物，包括急性恐惧的遗传生物标志物（即，恐惧 因此，控制注意力的障碍是一种很有前途的干预措施。 旨在针对可能维持各种症状的生物标志物的治疗类别 注意力训练技术（ATT）是一种神经行为干预方法。 由于其在减轻多种症状方面所表现出的有效性而引起了人们的关注 心理诊断虽然以完善的理论为基础，但 ATT 的变化机制是 一种拟议的机制可能是 ATT 促进之间的功能连接。 大脑中与自上而下的注意力执行控制有关的区域（腹内侧前额叶皮层 [vmPFC] 和背外侧前额皮质 [dlPFC]）和自下而上的注意网络（背侧前额皮质） 扣带皮层 [dACC] 和杏仁核），导致潜在问题的自上而下调节增加 自下而上的注意力过程涉及相同的大脑区域。 注意力过程也与恐惧反应（即惊吓反应）和恐惧学习有关 （即，一个人了解某种刺激是安全的或令人恐惧的速度）。 通过增加对注意力的执行控制，可以减少急性恐惧反应 拟议的随机临床试验将测试是否进行自我管理简报。 增强注意力控制的神经生物学干预（ATT）将减少急性恐惧反应，并且 这种变化是否与通过行为代理衡量的规范 dACC 功能相关。 预计从事 ATT 的人会表现出更高的注意力控制效率，从而降低 预计参与 ATT 的人也会表现出更强的 dACC。 通过行为代理来衡量的功能，并且随着注意力的增加，他们报告的恐惧会减少 此外，预计干预（ATT）将会在干预过程中增加。 通过确定的方法间接减少基于恐惧的心理诊断的症状 生物标志物（即注意力控制、dACC 功能、急性恐惧反应）以减少报告的症状。