Brain response associated with parent-based treatment for childhood anxiety disorders

与基于父母的儿童焦虑症治疗相关的大脑反应

基本信息

批准号：
10558712
负责人：
Dylan Grace Gee
金额：
$ 80.75万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10558712
关键词：
Absenteeism at work Address Aftercare Age Amygdaloid structure Anxiety Anxiety Disorders Behavior Brain Child Child Rearing Childhood Clinical Clinical Data Clinical Research Clinical Trials Cognitive Therapy Data Decision Making Dependence Diagnosis Distress Emotions Enrollment Evaluation Evidence based treatment Face Family Family Process Fright Functional Magnetic Resonance Imaging Generalized Anxiety Disorder Hand Human Hyperactivity Impairment Intervention Link Manuals Medial Mediator Medical Modification Morbidity - disease rate Mothers Neurobiology Parenting Education Parents Participant Pattern Prefrontal Cortex Process Psychopathology Public Health Randomized Reporting Risk Sampling Scanning Schools Separation Anxiety Social Functioning Symptoms Testing Translating Treatment Efficacy acceptability and feasibility anxiety reduction anxiety symptoms anxious barrier to care brain circuitry childhood anxiety cost design efficacy testing functional MRI scan informant innovation insight multimodality neural circuit novel offspring personalized medicine psychosocial randomized, clinical trials reduce symptoms research and development response social anxiety standard of care treatment duration treatment response treatment strategy

项目摘要

Currently, 50% of children do not benefit from evidence-based treatments for childhood anxiety disorders. This R61/R33 application proposes to test whether a novel entirely parent-based psychosocial intervention for childhood anxiety disorders engages amygdala-medial prefrontal cortex (mPFC) neural circuitry in the child's brain, implicated in children's reliance on parents to reduce their amygdala reactivity and anxiety; and whether changes in the target circuitry after treatment are associated with reductions in child anxiety. The R61 study will randomly assign 90 children (ages 7-10yrs) with primary anxiety disorders to one of two interventions: 1) Supportive Parenting for Anxious Childhood Emotions (SPACE), a novel completely parent- based treatment with no direct child involvement, that reduces children's anxiety by reducing parents' accommodation of their child's symptoms; or 2) Parent Educational Support (PES), a credible comparator intervention that is also entirely parent-based and controls for treatment duration and parent-therapist contact, but does not include any active modification of parental behavior. Before and after treatment, functional magnetic resonance imaging (fMRI) will be used examine children's reliance on parents to engage the target circuitry by comparing children's amygdala reactivity and mPFC connectivity in the presence of their mother and in the absence of their mother. We expect SPACE to reduce child reliance on parental presence to reduce amygdala reactivity, significantly more than PES. If this hypothesis is supported the R33 will be performed. The R33 will randomly assign 136 children (7-10yrs) with primary anxiety disorders to one of two interventions: 1) Parents participate in SPACE; or 2) Children receive cognitive-behavioral therapy (CBT), a standard of care treatment of known efficacy. We will use before and after fMRI and multi-informant/multi-modal child anxiety evaluations. We expect SPACE to reduce child reliance on parental presence to reduce amygdala reactivity, significantly more than CBT; We expect target engagement in SPACE to be associated with child anxiety symptom reduction; We expect SPACE will be feasible to deliver and acceptable to children and parents. This study is innovative in several ways and has the potential for large clinical and scientific impact. It is the first study to examine the impact of a psychosocial intervention on the neural circuitry of children with anxiety disorders, and the first study to examine the effects of an exclusively parent-only intervention with no child-therapist contact, on child brain circuitry. It will provide insight into the neurobiology of children's dependence on attachment figures for anxiety reduction, a process that contributes to the impairment and costs associated with childhood anxiety disorders. As many children are unable or unwilling to participate in therapy, results supporting the promise of SPACE as an effective way to reduce childhood anxiety would help to address a common barrier to treatment. Promising results from this study would provide the basis for a larger scale R01 clinical trial, to investigate the efficacy of SPACE and mediators and moderators of its effects.

目前，有50％的儿童没有从儿童焦虑症的基于证据的治疗中受益。此R61/R33应用程序建议测试一个完全基于父母的新颖的心理心理干预措施儿童焦虑症与儿童的杏仁核中额前额叶皮层（MPFC）神经回路大脑，涉及孩子对父母降低杏仁核反应性和焦虑的依赖；是否治疗后目标电路的变化与儿童焦虑的减少有关。 R61研究将随机分配90名患有主要焦虑症的儿童（7-10岁）干预措施：1）支持焦虑的童年情绪（太空）的育儿，这是一部完全父母的小说 - 基于没有直接儿童参与的基础治疗，可以减少父母的焦虑适应孩子的症状；或2）父母教育支持（PES），可靠的比较器干预措施也完全基于父母，并控制治疗持续时间和父母接触，但不包括对父母行为的任何主动修改。治疗前后，功能磁共振成像（fMRI）将用于检查儿童对父母的依赖来参与目标通过比较儿童的杏仁核反应性和MPFC连通性在母亲的存在下进行电路在没有母亲的情况下。我们预计空间可以减少儿童对父母的存在的依赖，以减少杏仁核反应性，明显超过PE。如果支持此假设，将执行R33。这 R33将随机分配136名患有主要焦虑症的儿童（7-10年）为两种干预措施之一：1）父母参加太空；或2）儿童接受认知行为疗法（CBT），这是一种护理标准处理已知功效。我们将在fMRI和多模式/多模式儿童焦虑症之前和之后使用评估。我们预计空间会减少儿童对父母存在的依赖，以降低杏仁核的反应性，比CBT明显更多；我们希望目标参与太空与儿童焦虑有关减轻症状；我们希望将空间可行，可以为孩子和父母接受和接受。这项研究在几种方面具有创新性，并且具有巨大的临床和科学影响。这是首次研究社会心理干预对儿童神经回路的影响焦虑症和首次研究仅父母干预的影响的研究儿童治疗师接触，在儿童脑电路上。它将提供有关儿童神经生物学的见解依赖于焦虑焦虑的依恋数字，这有助于损害和与儿童焦虑症相关的成本。由于许多孩子无法或不愿意参加治疗，支持空间的承诺作为减轻儿童焦虑的有效方法的结果将有助于解决常见的治疗障碍。这项研究的有希望的结果将为A提供基础较大的R01临床试验，以研究其影响的空间和介体和主持人的功效。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Childhood Avoidant/Restrictive Food Intake Disorder: Review of Treatments and a Novel Parent-Based Approach.

儿童回避/限制性食物摄入障碍：治疗回顾和基于父母的新方法。

DOI：
10.1891/jcpsy-d-20-00009
发表时间：
2020
期刊：
Journal of cognitive psychotherapy
影响因子：
0.7
作者：
Shimshoni,Yaara;Lebowitz,EliR
通讯作者：
Lebowitz,EliR

Family Accommodation and Separation Anxiety: The Moderating Role of Child Attachment.

家庭住宿和分离焦虑：儿童依恋的调节作用。

DOI：
10.21203/rs.3.rs-3621755/v1
发表时间：
2023
期刊：
Research square
影响因子：
0
作者：
Weeks,GillianA;Sakmar,Elcin;Clark,TaylarA;Rose,AnastasiaM;Silverman,WendyK;Lebowitz,EliR
通讯作者：
Lebowitz,EliR

Youth social functioning interacts with treatment arm, diagnosis, and gender to predict anxiety treatment outcome.

青少年社会功能与治疗组、诊断和性别相互作用，以预测焦虑治疗结果。

DOI：
10.1016/j.brat.2022.104160
发表时间：
2022
期刊：
Behaviour research and therapy
影响因子：
4.1
作者：
Etkin,RebeccaG;Marin,CarlaE;Silverman,WendyK;Lebowitz,EliR
通讯作者：
Lebowitz,EliR

Clinical Update: The Role of Family Accommodation in Youth Anxiety Treatment Outcomes.

DOI：
10.1080/23794925.2021.1981175
发表时间：
2022
期刊：
Evidence-based practice in child and adolescent mental health
影响因子：
0
作者：
通讯作者：

Affective language spreads between anxious children and their mothers during a challenging puzzle task.

DOI：
10.1037/emo0001203
发表时间：
2023-01
期刊：
Emotion
影响因子：
4.2
作者：
Erik C. Nook;Cristina Nardini;Sadie J. Zacharek;Grace Hommel;Hannah Spencer;Alyssa Martino;Allison Morra;Silvia Flores;Tess M. Anderson;Carla E Marin;W. Silverman;Eli R. Lebowitz;D. Gee
通讯作者：
Erik C. Nook;Cristina Nardini;Sadie J. Zacharek;Grace Hommel;Hannah Spencer;Alyssa Martino;Allison Morra;Silvia Flores;Tess M. Anderson;Carla E Marin;W. Silverman;Eli R. Lebowitz;D. Gee