Taylor Charles T, Stein Murray B, Simmons Alan N, He Feng, Oveis Christopher, Shakya Holly B, Sieber William J, Fowler James H, Jain Sonia
Department of Psychiatry, University of California San Diego, San Diego, California.
Department of Psychiatry, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California.
Biol Psychiatry. 2024 Mar 1;95(5):434-443. doi: 10.1016/j.biopsych.2023.07.024. Epub 2023 Aug 20.
Social disconnection is common and causes significant impairment in anxiety and depressive disorders, and it does not respond sufficiently to available treatments. The positive valence system supports social bond formation and maintenance but is often hyporesponsive in people with anxiety or depression. We conducted an experimental therapeutics trial to test the hypothesis that targeting positive valence processes through cognitive and behavioral strategies would enhance responsivity to social rewards, a core mechanism underlying social connectedness.
Sixty-eight adults who endorsed clinically elevated anxiety and/or depression with social impairment were randomized 1:1:1 to 5 (n = 23) or 10 (n = 22) sessions of amplification of positivity (AMP) treatment or waitlist (n = 23). Pre- to posttreatment change in striatal activity (primary outcome) during social reward anticipation was measured using functional magnetic resonance imaging, and reactivity to a social affiliation task (secondary) and self-reported social connectedness (exploratory) were examined. Primary analyses compared AMP (doses combined) versus waitlist. A second aim was to compare the effects of different doses.
AMP engaged the hypothesized treatment target, leading to greater striatal activation during anticipation of social rewards versus waitlist (d = 1.01 [95% CI = 0.42-1.61]; largest striatal volume). AMP yielded larger improvements in positive affect and approach behavior during the affiliation task (but not other outcomes) and social connectedness. Larger striatal and social connectedness increases were observed for 5-session versus 10-session AMP (d range = 0.08-1.03).
Teaching people with anxiety or depression strategies to increase positive thoughts, behaviors, and emotions enhances activity in brain regions that govern social reward processing and promotes social connectedness. Social reward sensitivity may be a transdiagnostic target for remediating social disconnection.
社会脱节现象普遍存在，会导致焦虑症和抑郁症患者出现严重功能损害，且现有治疗方法对此反应不足。正性效价系统支持社会联系的形成和维持，但在焦虑或抑郁患者中通常反应低下。我们进行了一项实验性治疗试验，以检验以下假设：通过认知和行为策略针对正性效价过程可增强对社会奖励的反应性，而社会奖励反应性是社会联系的核心机制。
68名认可临床焦虑和/或抑郁且伴有社会功能损害的成年人按1:1:1随机分为接受5次（n = 23）或10次（n = 22）积极情绪强化（AMP）治疗，或进入等待名单（n = 23）。使用功能磁共振成像测量社会奖励预期期间纹状体活动的治疗前至治疗后变化（主要结局），并检查对社会归属任务的反应性（次要结局）和自我报告的社会联系（探索性结局）。主要分析比较AMP（合并剂量）与等待名单。第二个目的是比较不同剂量的效果。
AMP激活了假设的治疗靶点，与等待名单相比，在预期社会奖励期间导致更大的纹状体激活（d = 1.01 [95% CI = 0.42 - 1.61]；最大纹状体体积）。AMP在归属任务期间（但不是其他结局）和社会联系方面在积极情感和趋近行为上产生了更大改善。与10次AMP治疗相比，5次AMP治疗观察到更大的纹状体和社会联系增加（d范围 = 0.08 - 1.03）。
教导焦虑或抑郁患者增加积极想法、行为和情绪的策略可增强大脑中控制社会奖励处理区域的活动，并促进社会联系。社会奖励敏感性可能是纠正社会脱节的一个跨诊断靶点。
