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Completed

NCT Number: NCT03655262

Treating Phobia With Multivoxel Neuro-reinforcement

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.

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Key information

Conditions

Phobia Anxiety Disorders Mental Disorders Phobic Disorders

Age range

18 year–65 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University of California, Los Angeles

Los Angeles, California, 90095, United States

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Individual has normal or corrected to normal vision
  • Individual has normal or corrected to normal hearing
  • Individual is competent to understand informed consent

Exclusion criteria

  • Individual is unable to fill in consent form correctly
  • Individual is unable to respond adequately to screening questions
  • Individual is unable to maintain focus or to sit during assessment
  • Individual has history of: neurological disease or defect (e.g., stroke, traumatic brain injury, schizophrenia or other psychological disorders, or seizures)
  • Individual has vision problems (including cataracts, amblyopia, or glaucoma)
  • Individual presents with: PTSD, Obsessive Compulsive Disorder, Substance Use Disorder, Current Major Depression, Bipolar Disorder, Psychosis, neurologic diagnoses or unstable serious medical conditions
  • Individual does not present with more than one object of specific phobia
  • Individual can touch the phobic object category during the pre¬treatment Behavioral Approach Test without presenting significant distress
  • Individual is currently prescribed psychotropic medication

Treatment and study plan

Unconscious Neuro-reinforcement

Behavioral

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.

Primary outcomes

  1. Change in Amygdala Reactivity

    Time frame: 10 days (measured at pre-treatment and post-treatment)

    The neural measure of difference in amygdala reactivity (measured by fMRI) to target phobic animals compared to control phobic animals from pre-treatment to post-treatment. Lower numbers (i.e. more negative numbers) indicate greater amygdala decrease and and better outcomes.

  2. Subjective Fear Post-treatment Minus Pre-treatment

    Time frame: 10 days (measured at pre-treatment and post-treatment)

    Subjective Fear Ratings of images of targeted phobic stimuli

    Minimum score of 0, Maximum score of 180, higher scores mean worse outcome.

Secondary outcomes

  1. Skin Conductance Response: Physiological Arousal Post-treatment Minus Pre-treatment

    Time frame: 10 days (measured at pre-treatment and post-treatment)

    Skin conductance to image presentation of targeted phobic stimuli post-treatment minus pre-treatment

  2. Fear Survey Schedule

    Time frame: 10 days (measured at pre-treatment and post-treatment)

    Subjective fear ratings of a list of typical phobic stimuli

    Minimum score of 40, maximum of 200, higher scores mean worse outcome.

  3. Stroop Task Post-treatment Minus Pre-treatment

    Time frame: 10 days (measured at pre-treatment and post-treatment)

    Measure of preferential allocation of attentional resources measured in reaction time (seconds) for visual presentation of the targeted phobic stimulus

Sponsors and collaborators

Lead sponsor

University of California, Los Angeles

Other

Registry information

Important dates

Study start
2018
Primary completion
2022
Study completion
2022
First posted
Aug 31, 2018
Registry last updated
Feb 2, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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