Rebecca B Price1, Logan Cummings2, Danielle Gilchrist3, Simona Graur3, Layla Banihashemi3, Susan S Kuo4, Greg J Siegle5. 1. Departments of Psychiatry and Psychology. 2. Department of Psychology, Florida International University. 3. Department of Psychiatry, University of Pittsburgh. 4. Department of Psychology, University of Pittsburgh. 5. Deparments of Psychiatry and Psychology, University of Pittsburgh.
Abstract
OBJECTIVE: Clinical anxiety is prevalent, highly comorbid with other conditions, and associated with significant medical morbidity, disability, and public health burden. Excessive attentional deployment toward threat is a transdiagnostic dimension of anxiety seen at both initial and sustained stages of threat processing. However, group-level observations of these phenomena mask considerable within-group heterogeneity that has been linked to treatment outcomes, suggesting that a transdiagnostic, individual differences approach may capture critical, clinically relevant information. METHOD:Seventy clinically anxious individuals were randomized to receive 8 sessions of attention bias modification (ABM; n = 41 included in analysis), a computer-based mechanistic intervention that specifically targets initial stages of threat processing, or a sham control (n = 21). Participants completed a mixed block/event-related functional MRI task optimized to discriminate transient from sustained neural responses to threat. RESULTS: Larger transient responses across a wide range of cognitive-affective regions (e.g., ventrolateral prefrontal cortex, anterior cingulate cortex, amygdala) predicted better clinical outcomes following ABM, in both a priori anatomical regions and whole-brain analyses; sustained responses did not. A spatial pattern recognition algorithm using transient threat responses successfully discriminated the top quartile of ABM responders with 68% accuracy. CONCLUSIONS: Neural alterations occurring on the relatively transient timescale that is specifically targeted by ABM predict favorable clinical outcomes. Results inform how to expand on the initial promise of neurocognitive treatments like ABM by fine-tuning their clinical indications (e.g., through personalized mechanistic intervention relevant across diagnoses) and by increasing the range of mechanisms that can be targeted (e.g., through synergistic treatment combinations and/or novel neurocognitive training protocols designed to tackle identified predictors of nonresponse). (PsycINFO Database Record (c) 2018 APA, all rights reserved).
RCT Entities:
OBJECTIVE: Clinical anxiety is prevalent, highly comorbid with other conditions, and associated with significant medical morbidity, disability, and public health burden. Excessive attentional deployment toward threat is a transdiagnostic dimension of anxiety seen at both initial and sustained stages of threat processing. However, group-level observations of these phenomena mask considerable within-group heterogeneity that has been linked to treatment outcomes, suggesting that a transdiagnostic, individual differences approach may capture critical, clinically relevant information. METHOD: Seventy clinically anxious individuals were randomized to receive 8 sessions of attention bias modification (ABM; n = 41 included in analysis), a computer-based mechanistic intervention that specifically targets initial stages of threat processing, or a sham control (n = 21). Participants completed a mixed block/event-related functional MRI task optimized to discriminate transient from sustained neural responses to threat. RESULTS: Larger transient responses across a wide range of cognitive-affective regions (e.g., ventrolateral prefrontal cortex, anterior cingulate cortex, amygdala) predicted better clinical outcomes following ABM, in both a priori anatomical regions and whole-brain analyses; sustained responses did not. A spatial pattern recognition algorithm using transient threat responses successfully discriminated the top quartile of ABM responders with 68% accuracy. CONCLUSIONS: Neural alterations occurring on the relatively transient timescale that is specifically targeted by ABM predict favorable clinical outcomes. Results inform how to expand on the initial promise of neurocognitive treatments like ABM by fine-tuning their clinical indications (e.g., through personalized mechanistic intervention relevant across diagnoses) and by increasing the range of mechanisms that can be targeted (e.g., through synergistic treatment combinations and/or novel neurocognitive training protocols designed to tackle identified predictors of nonresponse). (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Authors: Anderson M Winkler; Daniel S Pine; Anita Harrewijn; Elise M Cardinale; Nynke A Groenewold; Janna Marie Bas-Hoogendam; Moji Aghajani; Kevin Hilbert; Narcis Cardoner; Daniel Porta-Casteràs; Savannah Gosnell; Ramiro Salas; Andrea P Jackowski; Pedro M Pan; Giovanni A Salum; Karina S Blair; James R Blair; Mira Z Hammoud; Mohammed R Milad; Katie L Burkhouse; K Luan Phan; Heidi K Schroeder; Jeffrey R Strawn; Katja Beesdo-Baum; Neda Jahanshad; Sophia I Thomopoulos; Randy Buckner; Jared A Nielsen; Jordan W Smoller; Jair C Soares; Benson Mwangi; Mon-Ju Wu; Giovana B Zunta-Soares; Michal Assaf; Gretchen J Diefenbach; Paolo Brambilla; Eleonora Maggioni; David Hofmann; Thomas Straube; Carmen Andreescu; Rachel Berta; Erica Tamburo; Rebecca B Price; Gisele G Manfro; Federica Agosta; Elisa Canu; Camilla Cividini; Massimo Filippi; Milutin Kostić; Ana Munjiza Jovanovic; Bianca A V Alberton; Brenda Benson; Gabrielle F Freitag; Courtney A Filippi; Andrea L Gold; Ellen Leibenluft; Grace V Ringlein; Kathryn E Werwath; Hannah Zwiebel; André Zugman; Hans J Grabe; Sandra Van der Auwera; Katharina Wittfeld; Henry Völzke; Robin Bülow; Nicholas L Balderston; Monique Ernst; Christian Grillon; Lilianne R Mujica-Parodi; Helena van Nieuwenhuizen; Hugo D Critchley; Elena Makovac; Matteo Mancini; Frances Meeten; Cristina Ottaviani; Tali M Ball; Gregory A Fonzo; Martin P Paulus; Murray B Stein; Raquel E Gur; Ruben C Gur; Antonia N Kaczkurkin; Bart Larsen; Theodore D Satterthwaite; Jennifer Harper; Michael Myers; Michael T Perino; Chad M Sylvester; Qiongru Yu; Ulrike Lueken; Dick J Veltman; Paul M Thompson; Dan J Stein; Nic J A Van der Wee Journal: Transl Psychiatry Date: 2021-10-01 Impact factor: 7.989