Neurobiological mechanisms underlying effectiveness of CBT in IBS patients

CBT 对 IBS 患者有效性的神经生物学机制

• 批准号: 8731871
• 负责人: JEFFREY M LACKNER
• 金额: $ 51.87万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8731871
• 关键词: Address; Aftercare; Agreement; Amygdaloid structure; Anterior; Anxiety; Arousal; Base of the Brain; Biological Markers; Brain; Brain imaging; Cognitive; Cognitive Therapy; Control Groups; Disease; Disease Management; Dorsal; Effectiveness; Emotional; Funding; Gastrointestinal Diseases; Image; Insula of Reil; Irritable Bowel Syndrome; Lead; Magnetic Resonance Imaging; Measures; Medial; Mediating; Mediator of activation protein; Morphology; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Outcome Study; Pain; Participant; Patients; Pharmacological Treatment; Play; Predictive Factor; Prefrontal Cortex; Research Infrastructure; Rewards; Role; Self Efficacy; Structure; Symptoms; Testing; Thick; Treatment Efficacy; Treatment outcome; United States National Institutes of Health; Work; active control; cingulate cortex; effective therapy; follow-up; gray matter; morphometry; neurobiological mechanism; parent grant; programs; psychosocial; response; therapy outcome; treatment response; white matter

DESCRIPTION (provided by applicant): Irritable bowel syndrome (IBS) is a prevalent, often disabling gastrointestinal (GI) disorder without adequate pharmacologic treatment options. Non pharmacological treatment, most notably Cognitive Behavioral Therapy (CBT) may be an effective treatment for many IBS patients. The NIH funded IBS Outcome Study (IBSOS) is the most comprehensive CBT efficacy study to date, including standard and minimal contact versions of CBT and an active control (AC) condition. There is general agreement a) that altered brain-gut interactions, the primary target of CBT, play an important role in IBS symptoms, and b) that IBS as currently defined is likely to represent a heterogeneous disorder, implying any treatment will be most effective for only a subset of patients. In order to develop effective disease management programs for IBS, it is therefore critically important to understand mechanisms of action and factors predictive of treatment response. The proposed study, a synergistic interaction between two NIDDK funded programs, provides a unique opportunity to address this challenge: The recruitment, assessment and treatment components of the IBSOS parent grant combined with the brain imaging infrastructure at UCLA ([e-mail]) will enable this project to efficiently test specific hypotheses regarding both the neurobiological mechanisms underlying CBT treatment for IBS, and to develop predictive markers for which patients may benefit from these treatments. Using multimodal functional and structural MRI imaging of IBSOS participants before and after treatment in combination with psychosocial and symptom measures, this ancillary proposal will test a) the general hypothesis that the anterior insula functions as a "hub" for emotional arousal, cognitive as well as reward networks involved in IBS symptoms; b) that CBT will result in significant changes in these networks pre to post treatment with greater changes associated with better outcomes; c) that changes in activity, connectivity and structural integrity of these networks following treatment play an important role in mediating long term CBT outcomes; and d) that pre-treatment integrity of these networks will predict CBT response.

描述（由申请人提供）：肠易激综合征（IBS）是一种普遍的，通常是胃肠道（GI）疾病，没有足够的药理治疗选择。非药理治疗，最著名的是认知行为疗法（CBT）可能是许多IBS患者的有效治疗方法。 NIH资助的IBS结果研究（IBSO）是迄今为止最全面的CBT效力研究，包括CBT的标准和最小接触版和主动控制（AC）条件。有一般协定a）改变了大脑互动的相互作用，是CBT的主要目标，在IBS症状中起重要作用，b）IBS当前定义的IBS可能代表异质性疾病，这意味着任何治疗方法都将是最有效的仅一部分患者。为了为IBS制定有效的疾病管理计划，了解行动机制和预测治疗反应的因素非常重要。拟议的研究是两个NIDDK资助的计划之间的协同互动，为解决这一挑战提供了一个独特的机会：IBSOS父母赠款的招聘，评估和治疗组成部分与UCLA（[e-mail]）的脑成像基础设施相结合。使该项目能够有效地检验有关IBS CBT治疗的神经生物学机制的特定假设，并开发出患者可以从这些治疗中受益的预测标记。使用IBSOS参与者的多模式功能和结构性MRI成像，并在治疗前后与社会心理和症状措施结合使用，该辅助提案将检验a）前肌肉的总体假设，即前肌ul骨起着情绪唤醒，认知以及认知性以及认知性以及的“枢纽”参与IBS症状的奖励网络； b）CBT将导致治疗后的这些网络发生重大变化，并且与更好的结果相关的更改； c）治疗后这些网络的活动，连通性和结构完整性的变化在介导长期CBT结果中起着重要作用； d）这些网络的预处理完整性将预测CBT响应。