Using CBT to examine circuitry of frustrative non-reward in aggressive children

使用 CBT 检查攻击性儿童的沮丧无奖励回路

• 批准号: 8573643
• 负责人: Kevin A Pelphrey
• 金额: $ 41.63万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8573643
• 关键词: Address; Aftercare; Age; Aggressive behavior; Amygdaloid structure; Anterior; Area; Arousal; Behavior Therapy; Behavioral; Biological Markers; Blinded; Brain; Categories; Child; Classification Scheme; Clinical; Clinical effectiveness; Cognitive Therapy; Coupled; Cues; Data; Diagnostic; Disease; Distress; Dorsal; Educational process of instructing; Electroencephalography; Emotional; Emotions; Evaluation; Event-Related Potentials; Face; Feedback; Frustration; Functional Magnetic Resonance Imaging; Investigation; Learning; Measurement; Measures; Modeling; National Institute of Mental Health; Neurobiology; Neurosciences; Outcome; Outcome Measure; Parents; Perception; Prefrontal Cortex; Prevention; Problem Solving; Psychotherapy; Randomized; Randomized Controlled Trials; Reaction; Research; Research Priority; Rewards; Scanning; Signal Transduction; Source; Strategic Planning; Stream; Testing; Treatment outcome; Withdrawal; Work; activity marker; base; blood oxygen level dependent; brain behavior; callous unemotional trait; cingulate cortex; cognitive control; emotion regulation; face perception; impression; improved; indexing; interest; neural circuit; neuroimaging; neuromechanism; public health relevance; relating to nervous system; response; skills

DESCRIPTION (provided by applicant): Frustrative non-reward is defined by reactions elicited in response to withdrawal or prevention of reward, most notably reactive aggression. The neural mechanisms of reactive aggression involve heightened amygdala arousal in response to frustration coupled with hypoactivity of prefrontal regions that subserve emotion regulation. This is a proposal for a randomized controlled trial of cognitive-behavioral therapy (CBT) in children with high levels of aggression aimed at explicating the brain-behavior relationship of the frustrative non-reward construct. Because CBT teaches emotion regulation skills, the first objective of the study is to examine whether positive response to CBT for aggression will be associated with decreased activity in the amygdala, the brain area associated with emotional arousal, and increased activity in the brain areas associated with cognitive control of emotion, including the dorsal anterior cingulate cortex and ventromedial prefrontal cortex. Demonstrating that a change in the key nodes of the emotion regulation circuitry is associated with a reduction of reactive aggression will provide evidence to support the validity of the frustrative non-reward construct. The second objective is to explore the moderating effects of the biomarkers of impaired socioemotional perception and reward sensitivity in aggressive children with callous-unemotional traits on response to CBT. Eighty children with high levels of aggression across multiple traditional diagnostic categories, ages 8 to 16, will be randomly assigned to receive 12 sessions of CBT or 12 sessions of Supportive Psychotherapy. Clinical outcomes will be measured by the parent-ratings of aggressive behavior collected at baseline, midpoint and endpoint evaluations and the Improvement Score of the Clinical Global Impression Scale assigned by an independent evaluator (blinded rater). Children will also perform a frustration-induction Go-NoGo task and a task of emotional face perception during fMRI scanning and EEG recording at baseline and endpoint. The frustration-induction Go-NoGo task involves viewing a stream of objects and pressing the button in response to pre-determined experimental conditions. During a portion of the task, frustration is induced by loss of points that can be exchanged for a reward. This task has been shown to engage the neural circuitry of emotion regulation in an earlier fMRI study. The main contrasts of interest for the BOLD signal will be the difference between: (1) neutral versus frustration blocks of the Go-NoGo task, (2) neutral versus emotional faces, and (3) correct versus incorrect Go trials of the Go-NoGo. The main variables of interest for the evoked-related potentials will be: (1) the N2 component to the NoGo trials, (2) P3 component to correct and Feedback-Related Negativity to the incorrect Go trials, and (3) N170 and N250 ERPs to the face perception task. Consistent with the NIMH Strategic Research Priorities, if functional neuroimaging and electrophysiological variables can identify children who respond to cognitive-behavioral therapy for aggression, this can provide a neuroscience- based classification scheme that will improve treatment outcomes for children with aggressive behavior.

描述（由申请人提供）：令人沮丧的非回报是由响应戒断或预防奖励（尤其是反应性侵略）引起的反应定义的。反应性攻击的神经机制涉及响应于挫败感的杏仁核的增强，以及避免了饱和性的前额叶区域的不良性。这是对具有高水平侵略性的儿童进行认知行为疗法（CBT）的随机对照试验的提议，旨在阐明令人沮丧的非回报结构的脑行为关系。 Because CBT teaches emotion regulation skills, the first objective of the study is to examine whether positive response to CBT for aggression will be associated with decreased activity in the amygdala, the brain area associated with emotional arousal, and increased activity in the brain areas associated with cognitive control of emotion, including the dorsal anterior cingulate cortex and ventromedial prefrontal cortex. 证明情绪调节电路的关键节​​点的变化与减少反应性攻击有关，将提供证据以支持挫败感的非回报构造的有效性。第二个目标是探索具有恶心的人类情感特征对CBT反应的侵略性儿童的社会情感感知和奖励敏感性受损的生物标志物的调节作用。在多个传统诊断类别中，有80个具有高度侵略性的儿童，即8至16岁，将随机分配接受12次CBT或12次支持的支持性心理治疗。临床结果将通过基线，中点和终点评估收集的侵略性行为的父母评估以及由独立评估者（盲人评估者）分配的临床全球印象量表的改善得分来衡量。儿童还将在基线和端点上执行挫败感的诺戈任务，并在ficmri扫描和脑电图记录中进行情感面部感知的任务。挫败感诱导的GO-NOGO任务涉及查看对象流并按下按钮，以响应预定的实验条件。在一部分任务期间，挫败感是由于可以换取奖励的积分而引起的。在较早的功能磁共振成像研究中，该任务已被证明可以吸引情绪调节的神经回路。粗体信号的主要对比是 差异：（1）GO-Nogo任务的中性与挫折块，（2）中性与情感面孔，以及（3）正确与错误的GO Nogo试验。诱发相关电位的关注的主要变量将是：（1）N2分量的Nogo试验，（2） P3组件纠正和反馈相关的消极性对不正确的GO试验，以及（3）N170和N250 ERP对面部感知任务。与NIMH战略研究的重点一致，如果功能性神经成像和电生理变量可以识别儿童 应对认知行为疗法进行侵略，这可以提供基于神经科学的分类方案，该方案将改善侵略性行为儿童的治疗结果。