Neural Mechanisms of CBT Response in Hoarding Disorder

囤积症 CBT 反应的神经机制

基本信息

批准号：
8705606
负责人：
Michael C Stevens
金额：
$ 55.5万
依托单位：
HARTFORD HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-23 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8705606
关键词：
Affect Affective Aftercare Amygdaloid structure Anterior Attention Behavioral Biological Biological Markers Brain Brain region Child Welfare Clinical Cognitive Cognitive Therapy Comorbidity Compulsive Hoarding Control Groups Data Decision Making Disease Disease remission Distress Elderly Fire - disasters Functional Magnetic Resonance Imaging Goals Health Housing Imaging Techniques Impairment Injury Insula of Reil Intervention Laboratories Lead Learning Link Measures Memory Mental Health Modeling National Institute of Mental Health Obsessive-Compulsive Disorder Outcome Participant Patients Pattern Performance Pharmacological Treatment Population Process Psychopathology Public Health Public Housing Randomized Research Rewards Risk Services Simulate Staging Strategic Planning Symptoms Testing Treatment Efficacy United States National Institutes of Health Ventral Striatum Waiting Lists Work base biopsychosocial cognitive function decision-making capacity design disability executive function hemodynamics improved innovation interest meetings neural patterning neuroimaging neuromechanism novel psychologic psychosocial public health relevance relating to nervous system response social therapy development

项目摘要

DESCRIPTION (provided by applicant): The long-term goal of the proposed research is to improve clinical outcomes for Hoarding Disorder (HD), a common and potentially debilitating condition that poses a severe public health burden. The PI has developed and tested a cognitive-behavioral therapy (CBT) that appears moderately effective, although there is clear room for improvement. In the present study, we propose to merge this line of research with the PI's recent NIH-supported neuroimaging research that points to specific functional abnormalities in regions of interest (ROIs) related to cognitive and affective decision- making processes. Patients with HD (n = 80) will be randomized to CBT or wait list (WL). At pre-treatment, mid-treatment, and post-treatment, patients will undergo functional magnetic resonance imaging (fMRI) during an acquiring and discarding decision-making task that has been used successfully in our previous work. In addition, patients will complete a number of laboratory tasks designed to assess decision-making capacity and impairment. A group of healthy control (HC) participants (n = 40) will also complete these measures as a normative control group. The primary aim of the proposed study is to determine the extent to which the observed patterns of neural activity in HD change following CBT. Under this aim, we predict that HD patients (vs. HCs) will show greater hemodynamic activity in ROIs associated with cognitive and affective aspects of decision-making. We further predict that HD patients receiving CBT (vs. WL) will show decreased activity in those ROIs, and will no longer differ from HCs following CBT. A secondary aim of the proposed study is to determine the relationship between change in activity in brain regions of interest and hoarding-related symptoms and impairments. We expect, that hemodynamic activity in the target ROIs will correlate with symptoms of HD and with performance on decision-making tasks; and that change in brain activity will correspond to both symptom and mechanism changes over the course of treatment. Finally, an exploratory aim is to explore, using both data-driven and model-constrained approaches, patterns of pre-treatment neural activity that predict response to CBT. We predict that among treated HD patients, pre-treatment activity in the target ROIs will correlate significantly with HD symptom change from pre- to post- treatment. This study promotes the NIMH strategic plan by identifying and integrating biomarkers and behavioral indicators associated with HD (Strategy 1.3), by focusing on the biological and behavioral moderators of response to psychosocial intervention in this population (Strategy 3.1), and using research on the biological causes of disorder to inform and develop psychosocial interventions that target core features of disease (Strategy 3.1). Results of the proposed study are expected to elucidate the neural mechanisms of successful response to CBT treatment for hoarding patients, and to set the stage for further treatment development and possible improvements in outcome for this disorder.

描述（由申请人提供）：拟议研究的长期目标是改善囤积症（HD）的临床结果，这是一种常见且可能使人衰弱的疾病，会造成严重的公共卫生负担。 PI 开发并测试了一种认知行为疗法 (CBT)，虽然仍有明显的改进空间，但似乎效果中等。在本研究中，我们建议将这一研究方向与 PI 最近由 NIH 支持的神经影像学研究相结合，该研究指出了与认知和情感决策过程相关的感兴趣区域 (ROI) 中的特定功能异常。 HD 患者 (n = 80) 将被随机分配接受 CBT 或等待名单 (WL)。在治疗前、治疗中和治疗后，患者将在获取和放弃决策任务期间接受功能磁共振成像（fMRI），该任务已在我们之前的工作中成功使用。此外，患者将完成许多旨在评估决策能力和损伤的实验室任务。一组健康对照 (HC) 参与者 (n = 40) 也将作为规范对照组完成这些措施。本研究的主要目的是确定 CBT 后观察到的 HD 神经活动模式变化的程度。根据这一目标，我们预测 HD 患者（相对于 HC）将在与决策的认知和情感方面相关的 ROI 中表现出更大的血流动力学活动。我们进一步预测，接受 CBT（相对于 WL）的 HD 患者的 ROI 活动会减少，并且在 CBT 后将不再与 HC 不同。该研究的第二个目的是确定感兴趣的大脑区域的活动变化与囤积相关症状和损伤之间的关系。我们预计，目标 ROI 中的血流动力学活动将与 HD 症状以及决策任务的表现相关；大脑活动的变化将对应于治疗过程中症状和机制的变化。最后，探索性目标是使用数据驱动和模型约束的方法来探索预测 CBT 反应的治疗前神经活动模式。我们预测，在接受治疗的 HD 患者中，目标 ROI 中的治疗前活动将与治疗前到治疗后的 HD 症状变化显着相关。本研究通过识别和整合与 HD 相关的生物标志物和行为指标（策略 1.3），重点关注对该人群心理社会干预反应的生物和行为调节因素（策略 3.1），并利用对生物因素的研究来促进 NIMH 战略计划。疾病的原因，以告知和制定针对疾病核心特征的心理社会干预措施（策略 3.1）。拟议研究的结果预计将阐明囤积症患者对 CBT 治疗成功反应的神经机制，并为进一步治疗开发和可能改善这种疾病的结果奠定基础。