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: 9349892
• 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 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9349892
• 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; Guidelines; 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; Recruitment Activity; Research; Resistance; Reversal Learning; Rewards; Robin bird; Role; Scientist; Severities; Sleep; Sleep disturbances; Sleeplessness; Specificity; Suicide; Symptoms; Testing; Therapeutic; Training; Translational Research; Veterans; actigraphy; antidepressant effect; behavior measurement; biopsychosocial; career; clinically significant; comorbid depression; diaries; discount; discounting; experience; improved; innovation; novel; preference; programs; relapse risk; research study; reward processing; secondary analysis; severe mental illness; statistics; tool

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.

三分之二的抑郁症患者也已显示出符合失眠标准， 存在与临床差有关，对抑郁症治疗的抵抗力更大和 增加救济和自杀的风险。旨在确定共享的生物心理社会过程的研究 与抑郁症和失眠相关，对于开发减少这些工具的治疗工具都是必要的 负面结果并改善退伍军人的健康和生活质量。拟议的CDA-2目标奖励 处理，特别是处理与奖励相关的努力的处理，是这样的共同点。有个人 抑郁症已被证明比不沮丧的人更容易参与折扣的努力。 这意味着他们更有可能贬值需要更大努力才能获得的奖励。有一些 初步证据表明睡眠障碍可能导致努力打折，但尚未测试这种效果 在患有临床意义重大失眠的成年人中，以前关于抑郁症的努力折现的研究也没有 适当地表征了参与者失眠的严重程度和患病率。这个CDA-2旨在 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18至55岁的退伍军人，以代表抑郁症的连续体和 使用象限方法的失眠症状严重程度。这种方法将确保良好的分配 失眠/低抑郁症，失眠/低抑郁症，低失眠/高抑郁症和高抑郁症的退伍军人 高失眠/高抑郁严重程度用于利用连续预测的分析来最大化功率 并探索失眠和抑郁症对努力打折的组成影响。退伍军人将参加 在一周的主观（睡眠日记）和客观（行动学）评估，然后进行评估 努力打折。努力打折将以奖励的努力支出和 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关系的特异性， 退伍军人还将完成延迟的折现任务（奖励价值的度量）和概率 逆转学习任务（奖励学习的度量）。行为抑制/行为激活量表 对惩罚/敏感性奖励问卷的敏感性是自我报告的奖励措施 灵敏度，也将被施用。患有临床意义失眠的退伍军人 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，之后他们将接受 CBT-I。治疗后/候补列表评估睡眠和奖励处理将进行探索 失眠严重程度的变化是否与抑郁症的变化和努力折现有关。 失眠症被认为与增加的努力折现有关（即减少购买奖励的努力）， 假设失眠的改善与抑郁症的改善和 减少努力折扣。作为对失眠/努力折现关系特异性的评估是 探索性，没有关于失眠对奖励价值或学习的影响的先前假设。 此CDA-2将为申请人提供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（同事Philip Gehrman博士）。 迈克尔·塔斯（Michael Thase），评估和分析奖励指导行为（Robin Nusslock博士）和 授予技巧和专业发展（同事史蒂文·塞耶斯博士）。这项研究的发现可能 增强抑郁和失眠的退伍军人治疗的临床实践指南。