Attention Bias Modification for Anxiety: A Randomized Control Trial with Biomarke

焦虑的注意力偏差修正：Biomarke 的随机对照试验

• 批准号: 8630290
• 负责人: TRACY A DENNIS
• 金额: $ 34.69万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8630290
• 关键词: Address; Adult; Affect; Anxiety; Anxiety Disorders; Attention; Behavior; Behavioral; Biological; Biological Markers; Clinical; Cognitive; Cognitive Therapy; Computers; Development; Dimensions; Disease; Disease remission; Etiology; Evaluation; Event-Related Potentials; Exhibits; Functional Magnetic Resonance Imaging; Functional disorder; Galvanic Skin Response; Goals; Heart Rate; Individual; Individual Differences; Intervention; Intervention Studies; Knowledge; Maintenance; Measures; Mental disorders; Meta-Analysis; Modification; National Institute of Mental Health; Neurocognitive; Participant; Placebo Control; Placebos; Process; Psychiatric Diagnosis; Randomized; Randomized Controlled Trials; Reaction Time; Research; Resolution; Scalp structure; Selective Serotonin Reuptake Inhibitor; Severities; Societies; Staging; Stimulus; Strategic Planning; Stress; Symptoms; Testing; Training; Treatment Efficacy; United States National Institutes of Health; base; common treatment; cost; cost effective; economic cost; effective intervention; follow-up; innovation; intervention effect; millisecond; novel; public health relevance; relating to nervous system; remediation; response; social; stressor; treatment effect; treatment response

DESCRIPTION (provided by applicant): Anxiety disorders are the most common psychiatric diagnosis, affecting as many as 29% of people during their lifetime. In addition to the devastating personal cost of anxiety, the yearly economic cost to society has been estimated to be around 46.6 billion. Major progress has been made in the treatment of anxiety using selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT). However, obstacles to their wide-scale use and high remission rates (about 50%) suggest the need for complementary treatment approaches. Computer-based attention bias modification (ABM) treatment, which is brief, cost-effective, and easy to administer, addresses common treatment barriers and targets a key mechanism in pathological anxiety - the threat bias, or exaggerated attention towards threatening stimuli. ABM uses a modified version of the dot probe task to train anxious individuals to redirect attention away from threat. A recent meta-analysis of ABM effects on anxiety documents reductions in anxiety symptom severity, with effect sizes comparable to those for CBT. However, no research has evaluated specific neurocognitive mechanisms underlying ABM's effects on anxiety, nor attempted to identify biomarkers that can predict treatment response. The goal of the proposed project is to conduct the first large-scale RCT of ABM treatment for anxiety that integrates a neural biomarker approach to elucidate neurocognitive mechanisms underlying treatment efficacy and to test whether these biomarkers can identify those individuals for whom remediation of attention dysfunction via ABM will be most effective. Scalp-recorded event- related-potentials will be the biomarker due to their extremely high temporal resolution and sensitivity to automatic and controlled attentional processes that are implicated in ABM. The proposed research will pursue two Specific Aims: Aim 1 will test whether ABM treatment modifies ERP responses to threat in 90 anxious adults. We predict that adults who receive ABM (versus placebo) will exhibit at post-training: (a) significantly larger ERPs indicating increased control of attention to threat (N2/N2pc/P3); and (b) significantly reduced ERPs indicating diminished facilitated attention to threat (P1, P2) - although previous mixed evidence suggests these effects may be less robust than those for controlled attention. We will test the exploratory hypothesis that these changes in ERPs due to ABM will predict reductions in reaction-time based measures of threat bias. Aim 2 will test whether changes in ERPS due to ABM (detailed in Aim 1) are associated with reduced anxiety severity. We predict that changes in ERPs reflecting increased control of attention, and to a lesser degree reduced facilitation of attention to threat will predict amelioration of anxiety and stress reactivity following treatment. We will examine maintenance of treatment effects four months following treatment completion. We will also assess whether ERPS can be used to predict treatment response by testing the exploratory hypothesis that participants showing ERP responses at baseline indicating greater biased attention to threat (greater facilitation (larger P1/P2) and reduced control of attention (diminished N2/N2pc/P3)) will benefit most from remediation of attention dysfunction and thus show greatest reductions in anxiety severity and stress reactivity due to ABM. The proposed research, by integrating neural and behavioral markers, represents a crucial next step in understanding mechanisms underlying plasticity of the threat bias and remediation of anxiety. Such findings have the potential to yield high impact knowledge of the etiology of anxiety disorders, create more targeted, personalized, and cost-effective interventions for anxiety, and help predict individual differences in treatment response.

描述（由申请人提供）：焦虑症是最常见的精神诊断，一生中影响了多达29％的人。除了遭受毁灭性的​​个人焦虑成本外，对社会的年度经济成本估计约为466亿。使用选择性5-羟色胺再摄取抑制剂（SSRIS）和认知行为疗法（CBT）治疗焦虑方面取得了重大进展。但是，其广泛使用和高缓解率（约50％）的障碍表明需要采用互补治疗方法。基于计算机的注意力偏置修饰（ABM）治疗，简短，具有成本效益且易于管理，可以解决常见的治疗障碍，并针对病理性焦虑的关键机制 - 威胁偏见或对威胁刺激的关注。 ABM使用DOT探测任务的修改版本来训练焦虑的人，以将注意力转移到威胁上。最近对ABM的荟萃分析对焦虑症状症状严重程度减少的焦虑文件的影响，其效果大小与CBT相当。但是，尚无研究评估ABM对焦虑作用的影响的特定神经认知机制，也没有试图鉴定可以预测治疗反应的生物标志物。拟议项目的目的是进行ABM治疗的首个大规模RCT，以整合神经生物标志物方法，以阐明治疗功效的神经认知机制，并测试这些生物标志物是否可以识别那些通过ABM来补救注意力障碍的人是最有效的。头皮录制的事件 - 相关潜力将是生物标志物，因为它们的时间分辨率极高，并且对ABM中涉及的自动和受控注意过程的敏感性非常高。拟议的研究将追求两个具体的目标：AIM 1将测试ABM治疗是否会改变ERP对90名焦虑成年人的威胁的反应。我们预测，接受ABM（与安慰剂相对于安慰剂）的成年人将在培训后表现出来：（a）明显更大的ERP，表明对威胁的关注的控制增加了（N2/N2PC/P3）； （b）显着降低了ERP，表明促进对威胁的关注（P1，P2）的减少 - 尽管以前的混合证据表明，这些影响可能不如受控注意力的效果强大。我们将测试探索性假设，即由于ABM引起的ERP的这些变化将预测基于反应时间的威胁偏见测量中的减少。 AIM 2将测试因ABM引起的ERP的变化（AIM 1中的详细说明）是否与焦虑严重程度降低有关。我们预测，ERP的变化反映了人们对注意力的控制的增加，并且在较小程度上减少了对威胁的关注的促进，将预测焦虑的改善 和治疗后的压力反应性。我们将在治疗完成后四个月检查治疗效果的维持。我们还将通过测试探索性假设来评估ERP是否可以用于预测治疗反应，即在基线时显示ERP反应的参与者表明对威胁的关注更大（更大的促进（较大的P1/P2）（较大的P1/P2）（较大的P1/P2）和减少注意力的控制（N2/N2/N2PC/P3）减少（N2/N2PC/P3））将受益于注意力的压力和压力的补救措施大多数对焦虑的压力和临界点的压力大多。拟议的研究通过整合神经和行为标志物，代表了理解威胁偏见可塑性和焦虑补救的基础机制的重要下一步。这种发现有可能产生对焦虑症病因的高影响，从而为焦虑创造更有针对性，个性化和成本效益的干预措施，并有助于预测治疗反应中的个体差异。