Bethany A. Teachman - US grants

[unreadable] DESCRIPTION (provided by applicant): Cognitive models of anxiety propose that maladaptive schemata guide information processing so the anxious person selectively attends to threatening cues, interprets ambiguous cues as threatening, and preferentially recalls threat cues. There is robust evidence for many of the hypothesized cognitive biases, but little is known about how these biases relate to one another, how they relate to panic symptoms, or how they change in response to treatment. This proposal seeks to examine relationships among information processing measures in panic disorder, and to examine the patterns of change in cognitive and symptom measures over the course of treatment to determine which cognitive measures will predict symptom reduction. Further, this study would provide the first evaluation of implicit associations in panic disorder and consider how these associations respond to treatment. In addition, the study would examine the importance of changing catastrophic misinterpretations of bodily sensations to effect symptom reduction. To evaluate these questions, a group of patients with panic disorder (N = 30) would receive cognitive behavioral group therapy after completing an assessment battery including cognitive, affective, physiological and behavioral measures of panic, as well as information processing measures (tasks evaluating implicit associations in memory to reflect schematic processing, and tasks to evaluate attention and interpretation biases). The assessment battery would be completed pre-treatment, at 3 time points during the 12-week treatment protocol, and at post-treatment and 12-month follow-up. Longitudinal growth curve modeling would be used :o evaluate the trajectories of change and relationships among different cognitive and symptom measures of panic, and the follow-up period would allow prediction of return of fear. Control groups include a delayed- treatment group of persons with panic disorder (N = 30) who would complete the assessment battery at matched time points to the experimental group, and a non-anxious healthy control group (N = 30). [unreadable] [unreadable]

DESCRIPTION: Intrusive thoughts are unpleasant but familiar visitors to the mind. They are a common occurrence for older adults, but little is known about how the experience and consequences of intrusive thoughts change with age. Studying intrusive thoughts in older adults is important because unwanted mental activity is so ubiquitous, and because intrusive thoughts are central to emotion dysregulation, producing anxiety, depression and health problems that are tied to morbidity and mortality. We propose to study age differences in response to intrusive thoughts among healthy and anxious older adults to determine both the protective factors that can help us understand preservation of emotional, physical and mental health, and the risk factors that can help us learn how to intervene with those older adults who are struggling with emotional difficulties. In this proposal, we lay out a model to understand age-related differences in the recurrence of intrusive thoughts and ensuing distress. We will conduct a series of studies with older and younger adults using a thought suppression paradigm where participants will attempt to suppress their intrusive thoughts. This paradigm reliably elicits intrusive thoughts, which will allow us to evaluate age differences in the recurrence and attempts made to control these thoughts, meanings assigned to the thoughts, and the degree to which the thoughts provoke distress. Next, a series of manipulations are planned to examine the mechanisms underlying age differences in intrusive thoughts, such as manipulating the meaning assigned to thoughts and altering available working memory capacity. We will examine both age-related protective and risk factors for managing intrusive thoughts to determine when they contribute to emotion dysregulation versus when they contribute to successful aging. Finally, we will test the translational potential of the model, including brief intervention studies with anxious older adults to determine whether training these adults to assign less threatening meanings to their intrusive thoughts can reduce their distress. We will also evaluate the impact of intrusive thoughts and consequent distress on daily functioning in older adults, examining critical domains such as decision making. Ultimately, by examining the link between intrusive thoughts and distress, we can improve understanding of the interplay between emotion and cognition and their interaction with aging. PUBLIC HEALTH RELEVANCE: Establishing how older adults respond to intrusive thoughts, and teaching more adaptive responses to anxious older adults, is critical to promoting successful aging and public health. Intrusive thoughts have been linked to elevated cortisol, low self esteem, multiple forms of psychopathology and severe emotion dysregulation, which have in turn been shown to predict morbidity and mortality, such as increased risk of heart disease. Thus, the proposed studies will provide the basis for developing tools to prevent unhealthy responses to intrusive thoughts in older adults, and thereby help prevent emotion dysregulation and the resulting health problems.

? DESCRIPTION (provided by applicant): Approximately half of the U.S. population will experience a significant mental health problem during their lifetime, including 29% with anxiety pathology severe enough to qualify for an anxiety disorder diagnosis. Critically, the majority will not receive treatment, creating a serious need to consider alternative approaches to delivering mental health services that can meet needs on a larger scale. Cognitive Bias Modification (CBM) interventions for anxiety hold considerable promise as a way to meet these needs. These computer-based training programs are designed to alter biased ways of thinking, such as selective assignment of threat interpretations, which are known to cause and maintain anxiety. CBM programs have shown efficacy in the laboratory, and now have the potential to be tested and implemented on a broader scale using a web- based infrastructure. The current proposal aims to develop a web-based CBM infrastructure to train interpretations, and to evaluate and maximize the usability, acceptability, and feasibility of web-based CBM for anxiety symptoms. In Aim 1, a web-based interpretation bias training program will be built using the Project Implicit Mental Health (PIMH) infrastructure, an existing website directed by the Principal Investigator. This approach encourages efficiencies by capitalizing on the existing site and its heavy traffic. The training program will be piloted on a small test group of anxious participants (N=15) and an advisory board (N=8) of anxiety researchers, clinicians, and experts in CBM to obtain feedback on the programs' usability and acceptability. Aims 2 and 3 will evaluate target engagement, feasibility, and effectiveness of the web-based CBM program among individuals with moderate to severe anxiety symptoms, and will assess the inclusion of an anxious imagery prime to enhance CBM's effectiveness on the web. Participants will be randomly assigned to either 8 sessions of active CBM (100% positive scenario training) or a 50% positive/50% negative standard control condition, or a neutral, non-valenced control condition. Half the participants in each of these 3 conditions will receive an anxious imagery prime prior to each training session, and half will receive a neutral imagery prime, resulting in a 3 training condition x 2 prime design (N=300; target of n=50 per condition). Feasibility will be determined by analyses of recruitment, attrition, acceptance of randomization, adherence to and appropriateness of the measurement model, caseness, extent of missing data, and safety. Additionally, target engagement (change in interpretation bias), mechanisms underlying the prime's effects, and preliminary tests of effectiveness at reducing anxiety symptoms will be evaluated via assessments at baseline, and following sessions 3, 6, and 8, and at a 2-month follow-up. This research fits directly within the priorities of NIMH, given the proposal's focus on evaluating feasibility and effectiveness of a psychosocial intervention for a prevalent and impairing mental health problem that has strong potential for dissemination to large, diverse populations.

Project Summary/Abstract Approximately 25-30% of the U.S. population will experience anxiety pathology severe enough to qualify for an anxiety disorder diagnosis during their lifetime. Critically, the majority will not receive treatment, creating a serious need to consider alternative approaches to delivering mental health services that can meet needs on a larger scale. Cognitive Bias Modification (CBM) interventions for anxiety hold considerable promise as a way to meet these needs. These programs alter biased ways of thinking, such as selective assignment of threat interpretations, which are known to cause and maintain anxiety. CBM for interpretation bias (CBM-I) has established efficacy when administered via computer in the laboratory, and there is clear evidence for target engagement (i.e., change in interpretations, the identified mechanism). Now, effectiveness needs to be tested in the community, using sufficiently large samples to evaluate key moderators of its effects, including delivery method (computer vs. mobile phone) and the addition of minimal human contact (for those at risk of attrition). Addressing attrition is critical given high rates of drop out for web-based interventions. The PI's lab is ideally positioned to test moderators of CBM-I. Specifically, via the PI's MindTrails web site (established with the lab's prior NIMH R34MH106770 award), the lab already has the infrastructure to deliver CBM to the public and recruit large anxious samples. Moreover, the PI and Co-I have established infrastructure to do mobile sensing of mood and CBM-I delivery via mobile phones. Thus, the project can respond to NIMH's request for ?Effectiveness trials that can contribute to advancing the personalization of mental health care.? The current proposal aims to compare effectiveness and target engagement of CBM-I delivered via computer vs. mobile phone, and test if adding minimal human contact for participants at risk of dropout improves retention and outcomes. Study 1 will provide a pilot feasibility and user experience test of the CBM-I program on mobile phones. Study 2 will examine the lab's current online, computer-based CBM-I data to help determine empirical indicators of attrition. Study 3 will provide the primary test of moderators of effectiveness. Namely, in Study 3, N=840 high anxious participants will be randomized to one of 3 conditions: 1) CBM-I training delivered by computer (at existing MindTrails site); 2) CBM-I training delivered by mobile phone; 3) Control group- Psychoeducation only. CBM-I conditions include 5 weekly training sessions. Based on theoretically- and empirically-derived predictors of attrition, participants identified as high-risk for dropout in conditions 1 and 2 will then be randomly assigned to add minimal human contact (using the TeleCoach protocol) or no change. Using this adaptive intervention, known as Sequential, Multiple Assignment, Randomized Trial (SMART), the project can test both the effects of CBM-I delivery method and the added value of human contact to improve retention for participants at high-risk for dropping out.!