Massage for GAD: Neuroimaging and clinical correlates of response

广泛性焦虑症的按摩：神经影像学和反应的临床相关性

• 批准号: 10665241
• 负责人: Mark Hyman Rapaport
• 金额: $ 42.35万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-14 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10665241
• 关键词: 18 year old; Adult; Aftercare; American; Amygdaloid structure; Anger; Anterior; Antidepressive Agents; Anxiety; Anxiety Disorders; Area; Arousal; Blood Pressure; Brain; Brain imaging; Brain region; Clinical; Cognitive Therapy; Complementary therapies; Data; Disease; Distress; Emotional; Emotions; Exhibits; Face; Functional Magnetic Resonance Imaging; Functional disorder; Future; Galvanic Skin Response; Generalized Anxiety Disorder; Goals; Heart Rate; Image; Individual; Industry; Integrative Therapy; Investigational Therapies; Light; Masks; Massage; Medical; Mental Depression; Parasympathetic Nervous System; Patients; Peripheral; Physiological; Physiology; Play; Prefrontal Cortex; Prevalence; Psychiatric therapeutic procedure; Randomized; Research; Rest; Role; Selective Serotonin Reuptake Inhibitor; Sensory; Somatosensory Cortex; Specific qualifier value; Structure; Structure of postcentral gyrus; Sympathetic Nervous System; Symptoms; Syndrome; System; Therapeutic Trials; Time; Touch sensation; Well in self; active control; anxiety reduction; anxiety symptoms; arm; biological adaptation to stress; cingulate cortex; cortico-limbic circuits; depressive symptoms; distraction; efficacious treatment; emotion regulation; evidence base; heart rate variability; imaging study; loved ones; neural circuit; neural network; neuroimaging; psychiatric symptom; reduce symptoms; response; stressor; treatment group

GAD is a disorder of increased emotional reactivity, with its cardinal symptom, persistent worry, comprising an avoidance mechanism that decreases emotional reactivity to contrasting negative emotions. Evidence-based research has shown that both cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitor antidepressants are efficacious treatments for GAD; however, there is a need for additional acceptable, and widely available treatment approaches for patients suffering from GAD. Massage is a multi-billion dollar industry and in 2016-2017, over 47.1 million adult Americans received at least one massage. Massage is commonly used to increase the overall sense of wellbeing and decrease anxiety and our group has investigated the impact of Swedish massage therapy (SMT) on psychiatric symptoms and physiology. In a 6- week study of twice-weekly SMT vs a light touch (LT) control for GAD, SMT caused statistically significant decreases in anxiety and depression - demonstrating that SMT is biologically active and can impact symptoms of anxiety. Although imaging results in GAD remain inconsistent reduced functional connectivity (FC) within the corticolimbic circuit (amygdala, anterior cingulate cortex (ACC), prefrontal cortex (PFC)) is one of the most consistent findings. At this time there are no brain imaging studies investigating the impact of any type of whole body massage on brain function. The overall goal of this proposal is to identify the neural networks impacted by whole body massage in subjects with GAD. This study is a two-arm, randomized, masked study investigating the effects of SMT vs. LT control on brain activity in subjects with GAD. Medically healthy subjects ≥18 years of age with GAD will undergo fMRI followed by 2/week SMT (n=20) or LT (n=20) for 6 weeks, followed by a second fMRI. Resting state functional connectivity (rsFC) and FC during the fearful/angry faces task will be assessed. Aim 1 is to identify brain networks activated by SMT vs. LT using resting state fMRI and FC during the fearful faces task in subjects with GAD. The primary hypothesis is that relative to the LT control, SMT will result in greater pre-to- post-treatment increase in rsFC between areas known to be altered with anxiety disorders. Second, relative to LT control, subjects undergoing SMT will exhibit less activation in response to the fearful/angry faces task, as well as a greater pre-to-post-treatment decrease in brain activation. Lastly, it is hypothesized that pre-to-post-treatment increases in rsFC will inversely correlate with decreases in changes HAM-A scores, whereas pre-to-post-treatment decreases in brain activation in response to the fearful/angry faces task will be positively correlated with decreases in HAM-A scores within both treatment groups. Completion of this study will provide the first fMRI data evaluating the effects of SMT in comparison to an active control condition, on specific areas of brain connectivity and activity in subjects with GAD.

GAD 是一种情绪反应性增加的疾病，其主要症状是持续的担忧，包括 减少对对比负面情绪的情绪反应的回避机制。 研究表明，认知行为疗法（CBT）和选择性血清素再摄取抑制剂 抗抑郁药是广泛性焦虑症的有效治疗方法，但还需要更多可接受的药物； 针对广泛性焦虑症 (GAD) 患者的广泛可用的治疗方法耗资数十亿美元。 2016 年至 2017 年，超过 4710 万美国成年人至少接受过一次按摩。 通常用于增加整体幸福感和减少焦虑，我们的团队已经 研究了瑞典式按摩疗法 (SMT) 对精神症状和生理的影响 6-。 每周两次 SMT 与轻触 (LT) 控制对 GAD 的研究，SMT 造成统计显着 焦虑和抑郁减少 - 证明 SMT 具有生物活性并且可以影响症状 尽管 GAD 的影像学结果仍然不一致，但功能连接（FC）降低。 皮质边缘环路（杏仁核、前扣带皮层（ACC）、前额叶皮层（PFC））是最重要的环路之一。 目前还没有大脑成像研究调查任何类型的整体的影响。 该提案的总体目标是确定受影响的神经网络。 这项研究是一项双臂、随机、隐蔽研究。 研究 SMT 与 LT 控制对健康的广泛性焦虑症受试者大脑活动的影响。 年龄≥18 岁的 GAD 受试者将接受 fMRI，然后每周 2 次 SMT (n=20) 或 LT (n=20)，持续 6 周，然后进行第二次功能磁共振成像 (fMRI) 静息态功能连接 (rsFC) 和恐惧/愤怒期间的 FC。 将评估面部任务，目标 1 是使用静息状态识别 SMT 与 LT 激活的大脑网络。 FMRI 和 FC 在 GAD 受试者的恐惧面孔任务中的主要假设是相对的。 LT 控制、SMT 将导致治疗前后已知区域之间 rsFC 的增加更大 其次，相对于 LT 控制，接受 SMT 的受试者会表现出较少的变化。 响应恐惧/愤怒的面孔任务而激活，以及治疗前后的更大程度的减少 最后，据推测，治疗前后 rsFC 的增加呈负相关。 随着 HAM-A 评分变化的减少，而治疗前后大脑激活的减少 对恐惧/愤怒面孔任务的反应将与 HAM-A 分数的下降呈正相关 两个治疗组的完成将提供第一个功能磁共振成像数据来评估 SMT 对患者的影响。 与主动控制条件相比，受试者的大脑连接和活动的特定区域 G.A.D.