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疾病诊断，影响多达 29% 的人一生。除了焦虑对个人造成的毁灭性损失外，每年给社会造成的经济损失估计约为 466 亿美元。使用选择性血清素再摄取抑制剂（SSRI）和认知行为疗法（CBT）治疗焦虑已取得重大进展。然而，其广泛使用和高缓解率（约 50%）的障碍表明需要补充治疗方法。基于计算机的注意偏差修正（ABM）治疗，时间短、成本效益高且易于管理，解决了常见的治疗障碍，并针对病理性焦虑的关键机制——威胁偏差，或对威胁刺激的过度关注。 ABM 使用点探测任务的修改版本来训练焦虑的个体将注意力从威胁上转移开。最近一项 ABM 对焦虑效果的荟萃分析表明，焦虑症状严重程度有所减轻，其效果大小与 CBT 相当。然而，没有研究评估 ABM 对焦虑影响的具体神经认知机制，也没有试图识别可以预测治疗反应的生物标志物。拟议项目的目标是进行首个大规模 ABM 治疗焦虑的随机对照试验，该方法整合了神经生物标志物方法，以阐明治疗效果背后的神经认知机制，并测试这些生物标志物是否可以识别那些通过以下方式治疗注意力功能障碍的个体： ABM 将是最有效的。头皮记录的事件相关电位将成为生物标志物，因为它们具有极高的时间分辨率以及对 ABM 中涉及的自动和受控注意力过程的敏感性。拟议的研究将追求两个具体目标：目标 1 将测试 ABM 治疗是否可以改变 90 名焦虑成年人的 ERP 对威胁的反应。我们预测接受 ABM（与安慰剂相比）的成年人将在训练后表现出：(a) ERP 显着增大，表明对威胁的注意力控制能力增强 (N2/N2pc/P3)； (b) ERP 显着降低，表明对威胁的促进注意力减弱（P1、P2）——尽管之前的混合证据表明这些效应可能不如受控注意力的效应强。我们将测试探索性假设，即由于 ABM 导致的 ERP 变化将预测基于反应时间的威胁偏差度量的减少。目标 2 将测试 ABM 引起的 ERPS 变化（详见目标 1）是否与焦虑严重程度降低相关。我们预测，ERP 的变化反映了注意力控制的增加，以及在较小程度上减少了对威胁的注意力的促进，这将预测焦虑的改善 和治疗后的应激反应。我们将在治疗完成后四个月检查治疗效果的维持情况。我们还将通过测试探索性假设来评估 ERPS 是否可用于预测治疗反应，即参与者在基线时表现出 ERP 反应，表明对威胁有更大的偏见关注（更大的促进（更大的 P1/P2）和减少的注意力控制（N2/N2pc 减少） /P3)) 将从注意力功能障碍的治疗中获益最多，因此 ABM 可以最大程度地降低焦虑严重程度和压力反应性。拟议的研究通过整合神经和行为标记，代表了理解威胁偏见可塑性和焦虑补救机制的关键下一步。这些发现有可能产生关于焦虑症病因的高影响力知识，创造更有针对性、个性化和成本效益高的焦虑干预措施，并帮助预测治疗反应的个体差异。