Targeting adolescent depression symptoms using network-based real-time fMRI neurofeedback and mindfulness meditation

使用基于网络的实时功能磁共振成像神经反馈和正念冥想针对青少年抑郁症状

• 批准号: 10581837
• 负责人: RANDY PATRICK AUERBACH
• 金额: $ 104.4万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-21 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10581837
• 关键词: Address; Adolescent; Adult; Affect; Aftercare; Age; Attention; Attenuated; Brain; Childhood; Clinical; Coupled; Diagnosis; Disease; Dose; Double-Blind Method; Ecological momentary assessment; Emergency Situation; Environment; Exhibits; Functional Magnetic Resonance Imaging; Health Benefit; Intervention; Interview; Magnetic Resonance Imaging; Maintenance; Major Depressive Disorder; Medial; Mental Depression; Mental Health; Mindfulness Training; Motivation; Network-based; Neuroanatomy; Onset of illness; Outcome; Patient Self-Report; Patients; Pattern; Perception; Persons; Phase; Precision Medicine Initiative; Prediction of Response to Therapy; Prefrontal Cortex; Questionnaires; Randomized; Randomized, Controlled Trials; Recurrence; Relapse; Research; Rest; Sampling; Schizophrenia; Self Efficacy; Surgeon; Symptoms; Techniques; Testing; Therapeutic; Thinking; Time; Training; Treatment Efficacy; United States; Visual; child depression; cingulate cortex; clinical care; depressive symptoms; emotional distress; experience; health organization; improved; inattention; innovation; instrument; mindfulness; mindfulness meditation; neural; neural circuit; neurofeedback; novel; perceived stress; primary outcome; randomized, clinical trials; reduce symptoms; rumination; secondary outcome; skills; standard care; suicidal risk; sustained attention; symptomatic improvement

PROJECT SUMMARY Adolescent major depressive disorder (MDD) is common and debilitating. Presently, gold-standard treatments are only effective for approximately half of patients, underscoring the need to develop novel interventions, particularly to target core underlying mechanisms and more effectively treat this recurrent disorder. Rumination, the tendency to perseverate about depressive symptoms, contributes to MDD onset and predicts treatment non-response and relapse. At the neural level, rumination is characterized by elevated functional connectivity within the default mode network (DMN), and prior research also has consistently demonstrated patterns of DMN hyperconnectivity in MDD. Interestingly, mindfulness meditation, which trains attentional focus to the present moment, reduces perseverative thinking, ruminative tendencies, and depression symptoms. Further, our research and others have shown that adolescents can apply mindfulness practices to decrease perceived stress, increase sustained attention, and suppress DMN activity. Although mindfulness has profound mental health benefits, for some, mindfulness alone may not be sufficient to mitigate ruminative tendencies during a depressive episode. That is, MDD symptoms, including reduced motivation, inattention, and lack of self-efficacy, may impede a patient’s progress in successfully acquiring and utilizing mindfulness strategies necessary to change perceptions about one’s environment and relationships. To directly address this challenge, we propose using real-time fMRI neurofeedback to enhance the acquisition and utilization of mindfulness skills to better target DMN hyperconnectivity, rumination, and depressive symptoms. We developed a novel, 15-minute mindfulness-based, real-time neurofeedback (mbNF) paradigm whereby people observe a visual display of their brain activity and practice mindfulness to volitionally reduce DMN activation. In the R61 phase, 90 adolescents (ages 13-18) diagnosed with MDD will complete a 45-minute mindfulness training outside the scanner. To test target engagement of reducing DMN hyperconnectivity and optimal dosing, adolescents will then be randomized to receive either a 15- or a 30-minute mbNF session (n=45/dose group). If we meet our Go criterion (i.e., significantly reducing DMN hyperconnectivity), we will then proceed to the R33 phase to investigate whether mindfulness with mbNF outperforms mindfulness only. Thus, a new sample of 120 depressed adolescents (ages 13-18) will participate in a double-blind randomized clinical trial and receive mindfulness with the optimal mbNF dose (i.e., per the R61) or mindfulness only (n=60/group). We will test–using clinician-administered instruments, self-reports, and ecological momentary assessment– whether compared to mindfulness only, mindfulness with mbNF contributes to a greater reduction in clinician assessed depression symptoms (primary outcome) as well as decreased rumination (secondary outcome) across the post-treatment, 1-month, and 3-month assessments. As a whole, mbNF is directly in line with precision medicine initiatives, and if successful, could revolutionize clinical care for depressed adolescents.

项目概要 青少年重度抑郁症 (MDD) 很常见，但目前的金标准治疗方法却令人衰弱。 仅对大约一半的患者有效，强调需要开发新的干预措施， 特别是针对核心的潜在机制并更有效地治疗这种复发性疾病。 沉思，即坚持抑郁症状的倾向，会导致重度抑郁症（MDD）的发作和 预测治疗无反应和复发在神经水平上，沉思的特点是升高。 默认模式网络（DMN）内的功能连接一致，并且先前的研究也有 MDD 中的 DMN 超连接模式隐含地证明了冥想冥想，它训练 将注意力集中在当下，减少持续思考、沉思倾向和抑郁 此外，我们的研究和其他研究表明，青少年可以应用正念练习来治疗症状。 减少感知压力，增加持续注意力，并抑制 DMN 活动。 广泛的心理健康益处，对于某些人来说，仅靠正念可能不足以减轻沉思 抑郁发作期间的倾向，即MDD症状，包括动机降低、注意力不集中和 缺乏自我效能感，可能会阻碍患者成功获得和利用正念的进展 改变对环境和人际关系的看法所必需的策略，以直接解决这个问题。 挑战，我们建议使用实时功能磁共振成像神经反馈来增强对 正念技能可以更好地针对 DMN 超连接性、沉思和抑郁症状。 我们开发了一种新颖的、基于正念的 15 分钟实时神经反馈 (mbNF) 范式 因此，人们观察大脑活动的视觉显示，并练习正念以有意识地减少 在 R61 阶段，90 名诊断患有 MDD 的青少年（13-18 岁）将完成 45 分钟的 DMN 激活。 测试扫描仪外的正念训练减少 DMN 超连接性和 最佳剂量后，青少年将被随机分配接受 15 分钟或 30 分钟的 mbNF 课程 （n=45/剂量组）如果我们满足 Go 标准（即显着降低 DMN 超连接性），我们将 进入 R33 阶段，研究 mbNF 的正念是否优于仅正念。 120 名抑郁症青少年（13-18 岁）的新样本将参加一项双盲随机临床 试验并接受最佳 mbNF 剂量（即按照 R61）的正念或仅接受正念（n=60/组）。 我们将使用临床医生管理的仪器、自我报告和生态瞬时评估进行测试 与仅使用正念相比，正念结合 mbNF 是否有助于更大程度地减少临床医生 评估抑郁症状（主要结果）以及沉思减少（次要结果） 整个治疗后、1 个月和 3 个月的评估中，mbNF 与 直接一致。 精准医疗举措如果成功，可能会彻底改变抑郁青少年的临床护理。

项目成果

Mindfulness-based real-time fMRI neurofeedback: a randomized controlled trial to optimize dosing for depressed adolescents.

• DOI: 10.1186/s12888-023-05223-8
• 发表时间: 2023-10-17
• 期刊: BMC PSYCHIATRY
• 影响因子: 4.4
• 作者: Bloom, Paul A.;Pagliaccio, David;Zhang, Jiahe;Bauer, Clemens C. C.;Kyler, Mia;Greene, Keara D.;Treves, Isaac;Morfini, Francesca;Durham, Katherine;Cherner, Rachel;Bajwa, Zia;Wool, Emma;Olafsson, Valur;Lee, Ray F.;Bidmead, Fred;Cardona, Jonathan;Kirshenbaum, Jaclyn S.;Ghosh, Satrajit;Hinds, Oliver;Wighton, Paul;Galfalvy, Hanga;Simpson, H. Blair;Whitfield-Gabrieli, Susan;Auerbach, Randy P.
• 通讯作者: Auerbach, Randy P.