An Approach-Avoidance, Computational Framework for Predicting Behavioral Therapy Outcome in Anxiety and Depression

预测焦虑和抑郁行为治疗结果的避免接近计算框架

基本信息

批准号：
10651737
负责人：
ROBIN L AUPPERLE
金额：
$ 53.01万
依托单位：
LAUREATE INSTITUTE FOR BRAIN RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10651737
关键词：
Amygdaloid structure Animals Anxiety Anxiety Disorders Bayesian Analysis Behavior Behavior Therapy Behavioral Behavioral Mechanisms Biological Markers Brain Clinical Cognitive Cognitive Therapy Collaborations Computer Models Conflict (Psychology)Corpus striatum structure Cues Decision Making Depressive disorder Development Diagnosis Diagnostic Disease Dorsal Emotional Exposure to Face Freezing Fright Functional Magnetic Resonance Imaging Goals Individual Intervention Knowledge Measures Mental Depression Mental Health Modeling Mood Disorders Motivation Outcome Participant Patient Self-Report Patients Phase Process Psychological reinforcement Psychotherapy Randomized Relapse Reporting Research Domain Criteria Rewards Role Series Severities Supportive care Symptoms Testing Treatment Efficacy Treatment outcome Uncertainty Withdrawal Work anxiety symptoms anxiety treatment approach avoidance behavior approach behavior behavior prediction behavioral response clinical decision-making comorbidity computational basis computer framework demographics depressive symptoms efficacious treatment expectation experience habituation imaging study improved neural neuromechanism neuroregulation personalized approach predicting response psychologic recruit response standard care symptomatic improvement symptomatology theories therapy outcome treatment response years lived with disability

项目摘要

PROJECT SUMMARY Depression and anxiety disorders are highly comorbid and rank in the top ten causes of years lived with disability. Current gold-standard treatments are effective but do not work as well as we would like, with less than 50% experiencing long-lasting improvements. Two gold-standard behavioral interventions for depression and anxiety include behavioral activation, focused on enhancing approach behavior towards meaningful and reinforcing activities, and exposure-based therapy, focused on decreasing avoidance and challenging negative expectations through exposure to anxiety-provoking cues or situations. While these interventions have divergent approach versus avoidance treatment targets, there is currently little knowledge to guide clinical decision-making, i.e., to inform which strategies should be provided in the frequent case of comorbid anxiety and depression symptoms. Approach-avoidance decision-making paradigms focus on assessing neural and behavioral responses when faced with potential rewards and threats, tapping into processes though to be important for both anxiety and depression as well as behavioral activation and exposure-based therapy. For this study, we will recruit individuals reporting both anxiety and depression symptoms and randomize them to one of three different psychotherapeutic interventions delivered in a group setting, including (1) behavioral activation, (2) exposure-based therapy, and a non-specific therapy approach (3) supportive therapy. Participants will complete clinical, self-report, behavioral, and functional magnetic resonance imaging (fMRI) assessments before and after therapy. Clinical symptoms will also be assessed three and six months following therapy completion. We will use a computational approach to model the different factors that may influence one’s behavior during approach-avoidance decision-making, including drives to avoid threat versus approach reward and confidence versus uncertainty in one’s decisions. This project will accomplish the following aims (1) Determine how changes in brain and behavior responses during approach-avoidance conflict relate to changes in mental health symptoms with the different therapy approaches, (2) Determine the degree to which baseline brain and behavior responses during approach-avoidance conflict predict response to the different therapy approaches, above and beyond the influence of demographics and baseline symptom severity. Results will have enhance our understanding of how different psychotherapy approaches (behavioral activation, exposure-based therapy) may impact brain responses and decisions when faces with potential reward versus threat and approach versus avoidance drives. In addition, results will have important implications concerning the potential for a more personalized approach to psychotherapy, enhancing knowledge of which types of therapy strategies may be most beneficial for which individuals.

项目概要抑郁症和焦虑症是高度共病的，并且位列导致抑郁症和焦虑症共存多年的十大原因之一。目前的黄金标准治疗方法是有效的，但效果并不如我们所愿，且效果较差。超过 50% 的人经历了两种针对抑郁症的黄金标准行为干预措施。焦虑包括行为激活，侧重于增强接近行为以实现有意义和强化活动和基于暴露的治疗，重点是减少回避和挑战消极情绪尽管这些干预措施已经通过暴露于引起焦虑的线索或情况来实现期望。避免方法与治疗目标不同，目前指导临床的知识很少决策，即告知在常见的共病焦虑情况下应提供哪些策略和抑郁症状。回避决策范式侧重于评估神经和抑郁症状。面对潜在奖励和威胁时的行为反应，利用过程对于焦虑和抑郁以及行为激活和暴露疗法都很重要。在这项研究中，我们将招募同时报告焦虑和抑郁症状的个体，并将他们随机分配到在小组环境中提供的三种不同心理治疗干预措施之一，包括 (1) 行为激活，(2) 基于暴露的治疗和非特异性治疗方法 (3) 支持性治疗参与者将完成临床、自我报告、行为和功能磁共振成像。 (fMRI) 治疗前和治疗后的临床症状也将在三个月和六个月内进行评估。治疗完成后，我们将使用计算方法对可能的不同因素进行建模。在避免接近决策过程中影响一个人的行为，包括避免威胁与威胁的驱动力对待奖励和信心与决策的不确定性。该项目将实现以下目标（1）确定大脑和行为如何发生变化接近-回避冲突期间的反应与心理健康症状的变化有关。治疗方法，（2）确定基线大脑和行为反应的程度接近-回避冲突预测对不同治疗方法的反应，高于和超越人口统计数据和基线症状严重程度的影响。结果将增强我们对不同心理治疗方法（行为疗法）的理解。激活、基于暴露的疗法）可能会影响大脑在面对潜在的情况时的反应和决策此外，奖励与威胁、接近与回避的驱动力也很重要。关于更加个性化的心理治疗方法的潜力的影响，增强了解哪种类型的治疗策略可能对哪些个体最有益。

项目成果

期刊论文数量（20）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Visual cortical regions show sufficient test-retest reliability while salience regions are unreliable during emotional face processing.

DOI：
10.1016/j.neuroimage.2020.117077
发表时间：
2020-10-15
期刊：
NeuroImage
影响因子：
5.7
作者：
McDermott TJ;Kirlic N;Akeman E;Touthang J;Cosgrove KT;DeVille DC;Clausen AN;White EJ;Kuplicki R;Aupperle RL
通讯作者：
Aupperle RL

Neural processes of inhibitory control in American Indian peoples are associated with reduced mental health problems.

DOI：
10.1093/scan/nsac045
发表时间：
2023-02-23
期刊：
SOCIAL COGNITIVE AND AFFECTIVE NEUROSCIENCE
影响因子：
4.2
作者：
White, Evan J.;Demuth, Mara J.;Nacke, Mariah;Kirlic, Namik;Kuplicki, Rayus;Spechler, Philip A.;McDermott, Timothy J.;DeVille, Danielle C.;Stewart, Jennifer L.;Lowe, John;Paulus, Martin P.;Aupperle, Robin L.
通讯作者：
Aupperle, Robin L.

Impact of ibuprofen and peroxisome proliferator-activated receptor gamma on emotion-related neural activation: A randomized, placebo-controlled trial.

DOI：
10.1016/j.bbi.2021.05.023
发表时间：
2021-08
期刊：
Brain, behavior, and immunity
影响因子：
0
作者：
Cosgrove KT;Kuplicki R;Savitz J;Burrows K;Simmons WK;Khalsa SS;Teague TK;Aupperle RL;Paulus MP
通讯作者：
Paulus MP

Active coping strategies and less pre-pandemic alcohol use relate to college student mental health during the COVID-19 pandemic.

DOI：
10.3389/fpsyg.2022.926697
发表时间：
2022
期刊：
FRONTIERS IN PSYCHOLOGY
影响因子：
3.8
作者：
Akeman, Elisabeth;Cannon, Mallory J;Kirlic, Namik;Cosgrove, Kelly T;DeVille, Danielle C;McDermott, Timothy J;White, Evan J;Cohen, Zsofia P;Forthman, K L;Paulus, Martin P;Aupperle, Robin L
通讯作者：
Aupperle, Robin L

Long-term stability of computational parameters during approach-avoidance conflict in a transdiagnostic psychiatric patient sample.

DOI：
10.1038/s41598-021-91308-x
发表时间：
2021-06-03
期刊：
Scientific reports
影响因子：
4.6
作者：
Smith R;Kirlic N;Stewart JL;Touthang J;Kuplicki R;McDermott TJ;Taylor S;Khalsa SS;Paulus MP;Aupperle RL
通讯作者：
Aupperle RL