Multi-level Mechanisms of Behavioral Activation Therapy for Adolescent Depression

青少年抑郁症行为激活疗法的多层次机制

• 批准号: 10453989
• 负责人: W. EDWARD CRAIGHEAD
• 金额: $ 78.22万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-03 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10453989
• 关键词: Address; Adolescence; Adolescent; Adolescent Development; Age; Amygdaloid structure; Anterior; Behavior Therapy; Behavioral; Behavioral Mechanisms; Behavioral Symptoms; Biological Markers; Chronic; Clinical; Comprehension; Corpus striatum structure; Cues; Data; Decision Making; Detection; Development; Disease; Dorsal; Ecological momentary assessment; Emotions; Functional Magnetic Resonance Imaging; Future; Goals; Grant; Image; Individual; Insula of Reil; Intervention; Investigational Therapies; Knowledge; Link; Major Depressive Disorder; Measures; Mediating; Mediation; Mental Depression; Modeling; Modification; Monitor; Motivation; Participant; Patients; Pattern; Population; Prefrontal Cortex; Protocols documentation; Psychotherapy; Public Health; Research Domain Criteria; Rest; Rewards; Risk; Sampling; Scanning; Schedule; Severities; Techniques; Testing; Therapeutic Effect; Therapeutic Human Experimentation; Therapeutic Intervention; Treatment Efficacy; Ventral Striatum; Waiting Lists; avoidance behavior; base; child depression; contrast imaging; depressive symptoms; design; disability; effective therapy; efficacious treatment; functional MRI scan; imaging study; insight; interest; negative emotional state; neural circuit; neurobiological mechanism; neuroimaging; neuromechanism; novel; positive emotional state; precision medicine; relating to nervous system; response; reward anticipation; social; targeted treatment; therapy development; treatment response

Project Summary/Abstract Major Depressive Disorder (MDD) is a devastating clinical disorder and the leading cause of disability worldwide. Adolescence is a key developmental period during which risk for the development of depression is greatest. Behavioral Activation (BA) psychotherapy has emerged as a first-line treatment for adolescent depression, yet the underlying neurobiological mechanisms that mediate treatment efficacy remain unclear. Understanding these target mechanisms is fundamental to developing novel adaptations of BA, augmenting other treatments with BA, and designing new interventions informed by greater comprehension of neural target mechanisms. In the current application, we seek to identify the neural mechanisms that mediate treatment response during BA therapy for adolescent depression. Critically, reductions in avoidance behavior and successful BA treatment may occur through manipulation of multiple neural targets operating on different timescales between and/or within individuals. In cross-sectional neuroimaging studies of adolescent depression, the most common markers are hypo-responding to reward cues in the ventral striatum (VS) and ventromedial prefrontal cortex (vmPFC) and hyper-responding to negative information in the amygdala and the salience network–comprising the anterior insula (aI) and dorsal anterior cingulate (dACC). These patterns of hypo- and hyper-responding regions may independently or jointly contribute to behavioral avoidance by the RDoC concepts of reduced motivation for rewards and threat avoidance, respectively. Consequently, a fuller understanding of target engagement for BA requires multiple assessments linking trajectories of behavioral and symptom change with trajectories of change in these neural circuits over the course of therapy as opposed to just pre/post comparisons. To address these concerns, we propose to acquire ecological momentary assessment (EMA) and longitudinal neuroimaging data in a sample of 96 depressed adolescents while they complete a 16-week course of BA therapy. Three task-based fMRI scans will occur at baseline and after sessions 7 and 16, and will include a set of paradigms focused on assessing behavioral avoidance for monetary and social rewards. In addition, two brief “behavioral-scheduling-in-scanner” sessions will occur at sessions 3 and 9 during which the patient and therapist will engage in a component of BA therapy while the patient undergoes an fMRI scan. This “behavioral-secheduling-in-scanner” protocol will allow us to better determine the ecological validity of task-based measures of target engagement during psychotherapy. Taken together, these data will enable understanding of the neural mechanisms through which BA reduces avoidance behavior and thereby treats depression, Further, these data will establish a platform for developing future modifications of BA techniques and/or novel treatments based on identifiable neural targets.

项目摘要/摘要 重度抑郁症（MDD）是毁灭性的临床，是残疾的主要原因 在世界范围内。 最大的行为激活（BA）心理治疗已成为一线治疗 深度，但是介导效率的潜在神经生物学机制尚不清楚。 了解目标机制对于开发新型BA的适应至关重要，增强 通过BA的其他治疗方法，并设计由神经靶标的更大汇编的新的新干预措施 机制。 BA治疗期间对青少年抑郁症的反应。 通过操纵不同的神经目标，成功的BA裤子可能会发生 横截面神经成像研究之间的时间表 深度，最常见的标记是响应次数，以奖励腹侧纹状体中的提示（VS）和 腹侧前额叶皮层（VMPFC），并在杏仁核和杏仁核中进行超响应性信息 显着性网络 - 构成前岛（AI）和背缘（DACC） 低反应可能会独立或共同促进您的行为避免 RDOC减少奖励和避免威胁的动机的概念，更饱满 了解目标英语评估，将行为轨迹联系起来 在治疗过程中，这些神经回路的变化轨迹变化，症状改变 为了解决这些问题，我们建议获得生态 评估（EMA）和纵向神经影像学数据在96个深度为96个深度青少年的样本中 完成16周的BA治疗课程。 会议第7和16会议，并将无需评估避免行为的一组范式 货币和社交奖励。 患者和治疗师期间第3和9课将参与BA治疗的组成部分，而在a in in in in in in in in in w in in w in in in in in in in in in in in w in in in in in in in in in in in in in in in in in in in in in w in in h。 患者进行fMRI扫描。 拍摄。 这些数据一起通过BA降低了避免神经机制的理解 行为，从而治疗抑郁症，进一步，TESE数据将建立一个平台的未来 基于可识别神经靶标的BA技术和/或新型治疗方法的修改。