Augmentation of exposure therapy for high levels of social anxiety using post-exposure naps

使用暴露后小睡增强暴露疗法以治疗高水平的社交焦虑

• 批准号: 8932748
• 负责人: Edward F. Pace-Schott
• 金额: $ 26.1万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-24 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8932748
• 关键词: Adult; Affect; Aftercare; Ambulatory Monitoring; Anxiety; Anxiety Disorders; Architecture; Behavior Therapy; Behavioral; Blinking; Characteristics; Clinical; Cognitive; Cycloserine; DSM-IV; Diagnosis; Disease; Distress; Doctor of Philosophy; Effectiveness; Emotional; Enrollment; Ensure; Equipment and supply inventories; Etiology; Exercise; Exposure to; Extinction (Psychology); Fright; Funding; Galvanic Skin Response; General Hospitals; Goals; Gold; Health; Home environment; Hour; Hydrocortisone; Individual; Laboratories; Learning; Massachusetts; Measures; Medicine; Memory; Monitor; Napping; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Phase; Physiology; Polysomnography; Population; Preparation; Protocols documentation; Psyche structure; Psychologist; Psychophysiology; Public Health; Questionnaires; REM Sleep; Randomized; Relapse; Research; Role; Salivary; Sampling; Signal Transduction; Sleep; Slow-Wave Sleep; Social Anxiety Disorder; Social Phobia; Specific Phobia; Speech; Spiders; Stimulus; Therapeutic; Time; Trauma; Traumatic Stress Disorders; Treatment Cost; Treatment outcome; Trier Social Stress Test; Wakefulness; actigraphy; addiction; anxiety symptoms; arm; awake; base; clinical application; clinical predictors; clinically significant; conditioned fear; diaries; experience; fear memory; instrument; memory consolidation; method development; novel; novel therapeutics; prevent; response; social; social anxiety; standard care; standard measure; tool; treatment of anxiety disorders; virtual reality

DESCRIPTION (provided by applicant): Widely replicated studies demonstrate that sleep can enhance memory consolidation. Potential clinical applications of such findings have only begun to be explored. We have recently shown that nocturnal sleep following simulated exposure therapy for Specific Phobia (spiders) reduced both psychophysiological and self-reported reactivity when participants were re-exposed to the same and to novel spider stimuli. The proposed research will extend these findings to a more debilitating and clinically important anxiety disorder, Social Anxiety Disorder. We will examine whether post-exposure naps can be used to strengthen therapeutic extinction memories formed during exposure exercises used in the behavioral treatment of this disorder. A total of 32 individuals with diagnosed DSM-IV Social Anxiety Disorder will be enrolled in an exposure-based group treatment for this disorder. Eight successive therapy groups of 4 patients each will be offered during the 2-year funding period. The third and fourth sessions of this validated 5-week/5-session treatment will involve each participant delivering a speech on a topic individually chosen to elicit significant social anxiety Following both of these sessions, all 4 participants will go to the nearby Massachusetts General Hospital sleep laboratory where 2 will be given a 2-hour sleep opportunity with polysomnographic (PSG) monitoring and the other 2 will be similarly instrumented but undergo 2 hours of monitored quiet wakefulness (prior to session 3 participants will be randomized to the sleep or wakefulness arm). Before beginning treatment and within several days following the final treatment session, all participants will be individually assessed for social anxiety symptoms using standardized self-report instruments. At these same times, they will undergo a Trier Social Stress Test (TSST) modified for continuous psychophysiological monitoring that also includes repeated Subjective Units of Distress (SUDS) self report and sampling for salivary cortisol. In addition to laboratory PSG, ambulatory monitoring of home sleep with actigraphy and sleep diaries will take place at pre-treatment baseline and during the last 3 weeks of treatment. We hypothesize that those individuals allowed a 2-hour sleep opportunity following exposure sessions, compared to those who remained quietly awake, will show greater questionnaire- based clinical improvement as well as lesser psychophysiological and SUDS reactivity during the modified TSST. We further hypothesize that characteristics of sleep quality and architecture during naps, specifically durations of total sleep, REM sleep and slow-wave sleep as well as REM continuity, will predict clinical improvement and diminished TSST reactivity in those who napped. To help ensure that observed sleep effects are attributable to the two 2-hour sleep opportunities, we will control for actigraph and diary-measured sleep quality during treatment. Positive results will provide the first proof-of-principle for sleep augmentation of exposure therapy for a clinically significant anxiety disorder.

描述（由申请人提供）：广泛复制的研究表明睡眠可以增强记忆巩固。此类发现的潜在临床应用才刚刚开始探讨。我们最近表明，在模拟特定恐惧症（蜘蛛）模拟暴露疗法后的夜间睡眠会降低心理生理学和自我报告的反应性，当时参与者重新暴露于同一和新颖的蜘蛛刺激。拟议的研究将把这些发现扩展到更令人衰弱和临床上重要的焦虑症，社交焦虑症。我们将检查是否可以使用暴露后的小睡来加强该疾病行为治疗中使用的暴露锻炼期间形成的治疗灭绝记忆。共有32名患有DSM-IV社交焦虑症的人将接受基于暴露的该疾病的基于暴露的小组治疗。在2年的资金期间，将提供八个连续的治疗组，分别提供4例患者。这次验证的5周/5次课程治疗的第三个和第四个会议将涉及每个参与者在这两次会议之后发表有关一个单独的主题的演讲，以引起严重的社交焦虑，所有4名参与者都将在附近的马萨诸塞州一般医院睡眠实验室中进行2个小时的睡眠机会，并在2小时的睡眠机会上进行了监视，并在2小时内进行了启动，并在2小时内进行了2小时的监视（PSG），将与其他2小时（PSG）相似（PSG）（PSG）（PSG）（PSG）（PSG）（PSG）（PSG）（PSG）第3会议的参与者将被随机分配到睡眠或清醒部门）。在开始治疗之前，在最后的治疗后几天内，所有参与者都将分别评估社交焦虑症状 使用标准化的自我报告工具。在同一时间，他们将经过对连续心理生理学监测进行修改的Trier社会压力测试（TSST），该测试还包括反复的遇险主观单位（SUD）自我报告和唾液皮质醇的抽样。除实验室PSG外，还将在治疗前基线和治疗的最后3周对室内睡眠监测进行室内睡眠监测。我们假设，与那些保持静静清醒的人相比，这些人允许在暴露会议后进行2小时的睡眠机会，这将显示出更大的基于问卷调查的临床改善，并且在修改后的TSST期间会显示出较少的心理生理学和SUDS的反应性。我们进一步假设，小睡期间睡眠质量和建筑的特征，特别是总睡眠，REM睡眠和慢波睡眠以及REM连续性的持续时间，将预测临床改善并减少小睡的人的TSST反应性。为了帮助确保观察到的睡眠效果归因于两个2小时的睡眠机会，我们将控制Actigraph和Diary测量治疗过程中的睡眠质量。积极的结果将为临床意义焦虑症的暴露疗法增强睡眠疗法提供第一个原则证明。