Alice T. Sawyer, Ph.D. - US grants

DESCRIPTION (provided by applicant): Social Anxiety Disorder (SAD) is the fourth most prevalent mental disorder (Kessler, 1995) and typically has a chronic and unremitting course without treatment (Neal &Edelmann, 2003). Despite the high prevalence of SAD in the general population, only 20% of individuals with the disorder receive treatment (Coles et al., 2004), and of those individuals 40% do not respond to treatment (Liebowitz et al., 2005). Gaining a better understanding of the core neurocognitive mechanisms underlying SAD will likely lead to more effective treatments. The immediate goals of the research study proposed for this fellowship are to use functional magnetic resonance imaging (fMRI) to gain a better understanding of the neural mechanisms underlying attentional biases in SAD, while simultaneously providing invaluable training in the use of fMRI as a research tool. This study proposes to examine changes in neural activation as the result of a brief attention retraining intervention. Specifically, thirty-two patients with SAD will be randomized into an active attention retraining condition (N=16) or a placebo control condition (N=16). Regardless of condition, all subjects will participate in six, 20-minute sessions of a computerized attention training intervention at the Center for Anxiety and Related Disorders (CARD) at Boston University. Before and after completing this intervention, patients will be scanned at the Martinos Imaging Center at MIT and will complete an fMRI dot-probe task. Additionally, 16 healthy controls will also complete this task in the scanner on one occasion to allow the direct comparison of brain activation in healthy controls versus patients with SAD at pre-treatment. Specifically, this study aims to: (1) examine differences in patterns of activation in specific brain areas of interest (i.e., amygdala, insula, and the ventral attention network) in patients with SAD as compared to healthy controls during a dot-probe task at pre-intervention;(2) examine differences in neural activity as a result of an attention retraining intervention by directly comparing SAD patients assigned to the active retraining condition to those assigned to the control condition;and (3) examine changes in SAD symptomatology as a result of the attention retraining intervention. The broader goal of this study is to bridge affective neuroscience and attention modification research to better understand the utility of this relatively novel treatment approach for patients with SAD. The opportunity to conduct this research, take relevant coursework, and receive the guidance, support, and training of esteemed mentors, will aid in the pursuit of my long terms goals. PUBLIC HEALTH RELEVANCE: Social anxiety disorder (SAD) is the fourth most common psychiatric condition and is associated with distress and impairment in affected individuals. Individuals with SAD selectively attend to threatening social information and this attentional bias is hypothesized to play a causal role in the development of the disorder. The current proposal seeks to use functional magnetic resonance imaging (fMRI) to gain a better understanding of the neural mechanisms underlying attentional biases in SAD by examining changes in neural activation as the result of a brief attention retraining intervention. The findings will likely lead to a better understanding of the neural bases of SAD and attentional biases and contribute to the development of more focused interventions for SAD in the future.