Neurobiological mechanisms underlying effectiveness of CBT in IBS patients

CBT 对 IBS 患者有效性的神经生物学机制

• 批准号: 8542837
• 负责人: JEFFREY M LACKNER
• 金额: $ 50.05万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8542837
• 关键词: Address; Aftercare; Agreement; Amygdaloid structure; Anterior; Anxiety; Arousal; Base of the Brain; Biological Markers; Brain; Brain imaging; Cognitive; Cognitive Therapy; Control Groups; Disease; Disease Management; Dorsal; Effectiveness; Emotional; Funding; Gastrointestinal Diseases; Image; Insula of Reil; Irritable Bowel Syndrome; Lead; Magnetic Resonance Imaging; Measures; Medial; Mediating; Mediator of activation protein; Morphology; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Outcome Study; Pain; Participant; Patients; Pharmacological Treatment; Play; Predictive Factor; Prefrontal Cortex; Research Infrastructure; Rewards; Role; Self Efficacy; Structure; Symptoms; Testing; Thick; Treatment Efficacy; Treatment outcome; United States National Institutes of Health; Work; active control; cingulate cortex; effective therapy; follow-up; gray matter; morphometry; neurobiological mechanism; parent grant; programs; psychosocial; response; therapy outcome; treatment response; white matter

DESCRIPTION (provided by applicant): Irritable bowel syndrome (IBS) is a prevalent, often disabling gastrointestinal (GI) disorder without adequate pharmacologic treatment options. Non pharmacological treatment, most notably Cognitive Behavioral Therapy (CBT) may be an effective treatment for many IBS patients. The NIH funded IBS Outcome Study (IBSOS) is the most comprehensive CBT efficacy study to date, including standard and minimal contact versions of CBT and an active control (AC) condition. There is general agreement a) that altered brain-gut interactions, the primary target of CBT, play an important role in IBS symptoms, and b) that IBS as currently defined is likely to represent a heterogeneous disorder, implying any treatment will be most effective for only a subset of patients. In order to develop effective disease management programs for IBS, it is therefore critically important to understand mechanisms of action and factors predictive of treatment response. The proposed study, a synergistic interaction between two NIDDK funded programs, provides a unique opportunity to address this challenge: The recruitment, assessment and treatment components of the IBSOS parent grant combined with the brain imaging infrastructure at UCLA ([e-mail]) will enable this project to efficiently test specific hypotheses regarding both the neurobiological mechanisms underlying CBT treatment for IBS, and to develop predictive markers for which patients may benefit from these treatments. Using multimodal functional and structural MRI imaging of IBSOS participants before and after treatment in combination with psychosocial and symptom measures, this ancillary proposal will test a) the general hypothesis that the anterior insula functions as a "hub" for emotional arousal, cognitive as well as reward networks involved in IBS symptoms; b) that CBT will result in significant changes in these networks pre to post treatment with greater changes associated with better outcomes; c) that changes in activity, connectivity and structural integrity of these networks following treatment play an important role in mediating long term CBT outcomes; and d) that pre-treatment integrity of these networks will predict CBT response.

描述（由申请人提供）：肠易激综合症（IBS）是一种普遍存在的胃肠道（GI）疾病，如果没有足够的药物治疗选择，通常会致残。非药物治疗，尤其是认知行为治疗 (CBT) 可能是许多 IBS 患者的有效治疗方法。 NIH 资助的 IBS 结果研究 (IBSOS) 是迄今为止最全面的 CBT 疗效研究，包括标准和最小接触版本的 CBT 以及主动控制 (AC) 条件。人们普遍认为 a) 改变脑肠相互作用（CBT 的主要目标）在 IBS 症状中发挥重要作用，b) 目前定义的 IBS 可能代表一种异质性疾病，这意味着任何治疗都将是最有效的仅适用于一小部分患者。因此，为了制定有效的 IBS 疾病管理计划，了解作用机制和预测治疗反应的因素至关重要。拟议的研究是两个 NIDDK 资助项目之间的协同互动，为应对这一挑战提供了独特的机会：IBSOS 家长资助的招募、评估和治疗部分与加州大学洛杉矶分校 ([e-mail]) 的脑成像基础设施相结合，将使该项目能够有效地测试有关 CBT 治疗 IBS 的神经生物学机制的具体假设，并开发患者可能从这些治疗中受益的预测标记。通过使用 IBSOS 参与者在治疗前后的多模态功能和结构 MRI 成像，并结合心理社会和症状测量，该辅助提案将测试 a) 一般假设，即前岛叶作为情绪唤起、认知和认知功能的“枢纽”。奖励网络涉及IBS症状； b) CBT 将导致这些网络在治疗前和治疗后发生显着变化，更大的变化与更好的结果相关； c) 治疗后这些网络的活动、连通性和结构完整性的变化在调节长期 CBT 结果中发挥着重要作用； d) 这些网络的治疗前完整性将预测 CBT 反应。