“Treating Phobia With Multivoxel Neuro-reinforcement”
Specific phobias and other anxiety disorders, such as post-traumatic stress disorder (PTSD), represent a major mental health problem, and present a significant challenge to researchers because effective treatment usually involves repeated exposure to feared stimuli, and the high levels of associated distress can lead to termination of treatment. Recent advances in computational functional magnetic resonance imaging (fMRI) provide a method by which individuals may be unconsciously exposed to fearful stimuli, leading to effective fear extinction while eliminating a primary cause of attrition. Because such treatment happens directly in the brain, the investigators further hypothesize that the behavior outcomes may generalize particularly well to different contexts beyond the treatment period, and this approach, if successful, may be extended to treatments for posttraumatic stress disorder (PTSD) and other mental disorders.The objective of this study is to use the novel approach of neuro-reinforcement based on decoded fMRI information to reduce fear responses to fearful stimuli (e.g., spiders, heights) in individuals with phobias, directly and unconsciously in the brain, without repeatedly exposing participants to their feared stimuli. The Specific Aims of the R61 Phase are to: (1) confirm that our method engages the neurobiological target (amygdala reactivity to images of a feared object) in a population of individuals with specific phobia; and (2) to determine dosage-response optimization. The R61 Phase will confirm engagement of amygdala reactivity to fearful stimuli by our intervention method in patients suffering from phobia of everyday objects and animals (e.g., spiders). Varying the number of neuro reinforcement sessions across different subject groups (3 groups of 10 subjects each) and measuring reductions in the amygdala reactivity will demonstrate the robustness and mechanisms of target engagement. This will also enable assessment of the optimal dosage required to balance between maximal target engagement and imaging costs, in order to inform later studies. Our primary hypotheses are: i) our proposed intervention method will lead to significant reduction in fear to feared objects, via influence of the neurobiological target (amygdala reactivity, as measured by fMRI) at a suitable dosage level, this method can be successfully applied to patients suffering from phobias of everyday objects (e.g., spiders, syringes), to reduce clinically relevant fear measures.
Behavioral - Unconscious Neuro-reinforcement
Individuals will be unconsciously exposed to feared stimuli, leading to effective fear extinction while eliminating a primary cause of attrition.
Treating Phobia With Multivoxel Neuro-reinforcement