Treating Phobia With Multivoxel Neuro-reinforcement
Condition: Phobia
MeSH terms: Phobic Disorders
Study type: Interventional

Summary: 
      Specific phobias and other anxiety disorders 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 reduction while eliminating a primary cause of attrition.

      The objective of the current 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.

      Participants will be randomized into one of three groups of varying neuro-reinforcement
      sessions (1, 3, or 5). They will complete tests of subjective fear and directed attention
      while being scanned by fMRI to measure engagement of amygdala activity to fearful stimuli as
      well as measured through other indicators of fear such as skin conductance response.
    

Detailed description: 
      Anxiety disorders, the most common group of mental disorders in the United States, represent
      a major mental health problem. Phobias, in which fear and anxiety are triggered by a specific
      stimulus or situation, are the largest category of anxiety disorders and affect 5 - 12% of
      the world's population.

      Exposure-based therapies are effective in reducing symptoms, but their effectiveness depends
      on the individual's capacity or willingness to consciously confront their feared object. The
      associated distress can be so extreme that it prevents patients from seeking treatment, and
      contributes to attrition from exposure once treatment begins. As a result, there is an unmet
      need for treatment that minimizes attrition and subjective patient discomfort.

      The current study uses a novel technique of neuro-reinforcement based on decoded fMRI
      information to reduce fear responses to fearful stimuli directly and unconsciously without
      repeatedly exposing participants to those stimuli. The goals are to (1) confirm that our
      method decreases amygdala reactivity to images of phobic stimuli as well as (2) determine
      dosage-response optimization.
    

Intervention name(s): Unconscious Neuro-reinforcement
Intervention type(s): Behavioral
Intervention description(s): Individuals will complete an implicit fmri neuro-reinforcement task where real-time brain activity is matched to a desired activation. Individuals will also receive financial reward for activating the desired activation. Visual feedback will be presented to indicate how well individuals' brain activity matches the desired activation. Individuals will complete x day(s) of neuro-reinforcement.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: unconscious fear extinction; anxiety disorders; decoded neuro-reinforcement