The Role of Effort Discounting in the Link between Insomnia and Depression

努力折扣在失眠和抑郁之间的联系中的作用

• 批准号: 10563118
• 负责人: Elaine M Boland
• 金额: --
• 依托单位: PHILADELPHIA VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10563118
• 关键词: Adult; Affect; Aftercare; Age; Behavior; Behavioral; Behavioral inhibition; Caring; Clinical; Clinical Practice Guideline; Clinical Trials; Cognitive Therapy; Comorbid Insomnia; Depressed mood; Development; Ensure; Exhibits; Expenditure; Future; Health; Individual; Intervention; Lead; Learning; Link; Measures; Mental Depression; Mental Health; Mentors; Methods; Mood Disorders; Neurosciences; Outcome; Participant; Pathway interactions; Patient Self-Report; Play; Prevalence; Process; Psychopathology; Punishment; Quality of life; Questionnaires; Randomized; Research; Resistance; Reversal Learning; Rewards; Robin bird; Role; Scientist; Severities; Sleep; Sleep disturbances; Sleeplessness; Specificity; Suicide; Symptoms; Testing; Therapeutic; Training; Translational Research; Veterans; Waiting Lists; actigraphy; antidepressant effect; behavior measurement; biopsychosocial; career; clinically significant; comorbid depression; diaries; discounting; experience; improved; innovation; novel; preference; programs; recruit; relapse risk; research study; reward processing; secondary analysis; severe mental illness; sleep health; statistics; tool; treatment guidelines

Two-thirds of individuals with depression have also been shown to meet criteria for insomnia, the presence of which is associated with poor clinical course, greater resistance to depression treatment and an increased risk for relapse and suicidality. Research aimed at identifying the shared biopsychosocial processes relevant to both depression and insomnia is necessary to develop the therapeutic tools to reduce these negative outcomes and improve the health and quality of life of Veterans. The proposed CDA-2 targets reward processing, specifically the processing of reward-relevant effort, as one such commonality. Individuals with depression have been shown to engage more readily in effort discounting than non-depressed individuals, meaning that they are more likely to devalue rewards that require greater effort to obtain. There is some preliminary evidence that sleep disturbance may lead to effort discounting, but this effect has not been tested in adults with clinically significant insomnia, nor have previous studies of effort discounting in depression adequately characterized the severity and prevalence of insomnia among participants. This CDA-2 aims to evaluate the extent to which the processing of reward-relevant effort is meaningfully related to insomnia. The study will involve 132 Veterans ages 18 – 55 selected to represent a continuum of depression and insomnia symptom severity utilizing a quadrant approach. This approach will ensure a good distribution of Veterans with low insomnia/low depression, high insomnia/low depression, low insomnia/ high depression, and high insomnia/high depression severity for an analysis that utilizes continuous predictors to maximize power and explore the component effects of insomnia and depression on effort discounting. Veterans will participate in a week of subjective (sleep diary) and objective (actigraphy) assessments of sleep followed by assessments of effort discounting. Effort discounting will be measured with the Effort Expenditure for Rewards and the Progressive Ratio Tasks, behavioral measures that provide estimates of the effort subjects are willing to put forth for monetary rewards. To assess the specificity of the relationship of insomnia and reward processing, Veterans will also complete the delayed discounting task (a measure of reward valuation), and the probabilistic reversal learning task (a measure of reward learning). The Behavioral Inhibition/Behavioral Activation Scales and The Sensitivity to Punishment/Sensitivity to Reward Questionnaire are self-report measures of reward sensitivity and will also be administered. Veterans with clinically significant insomnia (i.e., Veterans in the high insomnia/low depression and high insomnia/high depression groups) will be randomly assigned to Cognitive Behavioral Therapy for Insomnia (CBT-I) or to a 6-week waitlist control period, after which they will receive CBT-I. Post-treatment/waitlist assessments of sleep and reward processing will be conducted to explore whether changes in insomnia severity are related to both changes in depression and effort discounting. Insomnia is hypothesized to be related to increased effort discounting (i.e., reduced effort to pursue rewards), and improvements in insomnia are hypothesized to be correlated with both improvements in depression and reduced effort discounting. As assessments of the specificity of the insomnia/effort discounting relationship are exploratory, there are no a priori hypotheses as to the effects of insomnia on reward valuation or learning. This CDA-2 will provide the applicant with focused training in translational sleep and mental health research (primary mentor Dr. Philip Gehrman), clinical trial methods and advanced statistics (co-mentor Dr. Michael Thase), assessment and analysis of reward guided behavior (co-mentor Dr. Robin Nusslock) and grantsmanship and professional development (co-mentor Dr. Steven Sayers). Findings from this study could enhance clinical practice guidelines for the treatment of Veterans with depression and insomnia.

抑郁症患者中有三分之二也符合失眠标准， 其存在与临床差不良有关，对剥夺的抵抗力更大和 增加复发和自杀的风险。 与抑郁症和失眠既相关 负面结果并改善退伍军人的健康和生活质量。 处理与奖励相关的努力的处理，作为一个共同点 与不抑郁的人相比 这意味着越喜欢贬值需要更大努力才能获得的奖励。 初步证据表明睡眠障碍可能会导致努力打折，但尚未测试这种效果 在患有临床上显着失眠的成年人中，抑郁症的努力折扣也没有 充分表征了参与者中失眠的严重性和流行率。 评估与奖励相关的努力的处理程度与失眠有意义地相关。 该研究将涉及132名年龄18-55岁的退伍军人，以代表深度的连续体和 使用象限方法，失眠症状使这种方法确保了良好的数字。 低失眠/低抑郁症，高失眠/低深度，低失眠/高深度和抑郁症的退伍军人。 高失眠/高抑郁严重程度，用于安排，利用连续预测器最大化功率 并探索失眠和剥夺努力的成分影响 在一周的主观（睡眠透射）和客观（Actraphy）睡眠评估之后进行评估 努力打折。 渐进比率任务，提供努力主题估算的行为措施愿意提出 货币奖励评估失眠和奖励处理的特殊性 退伍军人还将编译延迟的折扣任务（奖励估值的度量） 逆转学习任务（奖励学习的量度）。 对惩罚/敏感性奖励问卷的敏感性是自我报告的奖励措施 敏感性，也将施用具有临床意义的退伍军人（即 失眠/低抑郁和高失眠/高抑郁组）将随机分配给认知 失眠（CBT-I）或为期6周的候补控制期的行为疗法，之后将接受 CBT-I。 失眠症的变化是否已将抑郁症的变化和努力折现的变化灭绝。 失眠是与增加的努力折现有关的（即减少追求奖励的努力） 假设失眠症的改善与抑郁症的改善相关 减少折扣的评估。 探索性，关于失眠对奖励估值或学习的影响没有先验的假设。 这款CDA-2为申请人提供了转化睡眠和心理健康的重点培训 Research（主要导师Philip Gehrman博士），临床试验方法和高级统计学（Co-Contor Dr. 迈克尔·塔斯（Michael Thase），评估和分析奖励指导行为（Robin Nusslock博士）和 授予和专业发展（同事史蒂文·塞耶斯博士）。 增强抑郁和失眠的退伍军人治疗的临床实践指南。

项目成果

Antidepressant effects of acute sleep deprivation are reduced in highly controlled environments.

在高度控制的环境中，急性睡眠剥夺的抗抑郁作用会降低。

• DOI: 10.1016/j.jad.2023.07.116
• 发表时间: 2023
• 期刊: Journal of affective disorders
• 影响因子: 6.6
• 作者: Goldschmied,JenniferR;Boland,Elaine;Palermo,Emma;Barilla,Holly;Dinges,DavidF;Detre,JohnA;Basner,Mathias;Sheline,YvetteI;Rao,Hengyi;Gehrman,Philip
• 通讯作者: Gehrman,Philip

Do financial incentives increase mental health treatment engagement? A meta-analysis.

• DOI: 10.1037/ccp0000737
• 发表时间: 2022-06
• 期刊: JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
• 影响因子: 5.9
• 作者: Khazanov, Gabriela K;Morris, Paige E;Beed, Alexander;Jager-Hyman, Shari;Myhre, Karoline;McKay, James R;Feinn, Richard S;Boland, Elaine M;Thase, Michael E
• 通讯作者: Thase, Michael E

Preliminary support for the role of reward relevant effort and chronotype in the depression/insomnia comorbidity.

初步支持奖励相关努力和时间型在抑郁/失眠共病中的作用。

• DOI: 10.1016/j.jad.2018.08.057
• 发表时间: 2019
• 期刊: Journal of affective disorders
• 影响因子: 6.6
• 作者: Boland,ElaineM;Bertulis,Kassondra;Leong,ShirleyH;Thase,MichaelE;Gehrman,PhilipR
• 通讯作者: Gehrman,PhilipR

Does insomnia treatment prevent depression?

• DOI: 10.1093/sleep/zsad104
• 发表时间: 2023-04-08
• 期刊: SLEEP
• 影响因子: 5.6
• 作者: Boland, Elaine M.;Goldschmied, Jennifer R.;Gehrman, Philip R.
• 通讯作者: Gehrman, Philip R.

Identifying predictors of the amount of veteran participation in cognitive behavioral therapy for insomnia in the Veterans Affairs health care system.

确定退伍军人事务部医疗保健系统中退伍军人参与失眠认知行为治疗的预测因素。

• DOI: 10.1037/ser0000818
• 发表时间: 2023
• 期刊: Psychological services
• 影响因子: 2.3
• 作者: Tighe,CaitlanA;Berlin,GregoryS;Boland,ElaineM;Miller,KatherineE;Bramoweth,AdamD
• 通讯作者: Bramoweth,AdamD