Dr. Robin Aupperle is applying for the Mentored Patient-Oriented Career Development Award (K23) to support her development as an independent researcher using neuroscientific methods to inform the behavioral treatment of anxiety disorders. Clinicians and patients currently have little knowledge to guide them when deciding whether or not to embark on therapy or how to modify manualized therapy to optimize individual treatment. Dr. Aupperle's long-term career goal is to use knowledge regarding brain-behavior relationships to develop highly targeted behavioral interventions for anxiety disorders. More specifically, the aim would be that an individual patient could be assessed using a neurobehavioral battery to determine which therapy modules to use for optimizing response. The proposed research will accomplish the first steps towards this goal by investigating whether levels of approach (i.e., reward) and avoidance (i.e., threat) motivations, or the ability to arbitate these motivations can be used to identify individuals unlikely to respond to exposure-based therapy for generalized anxiety disorder (GAD). This project will use a task Dr. Aupperle recently developed to probe brain and behavior responses during the arbitration of approach and avoidance motivations in combination with other tasks and questionnaires relevant to approach and avoidance processing. The achievement of Dr. Aupperle's career goals, and the specific research objectives of this application, requires expertise related to current behavioral interventions, treatment outcome research, neuroimaging methods and analyses, and statistical methods for aggregating across multiple levels of analyses and modeling longitudinal datasets. Based on her prior research and clinical training, Dr. Aupperle has demonstrated expertise in functional neuroimaging and current psychological interventions for anxiety. The proposed training plan will provide further mentorship, coursework, and hands-on experience in advanced statistical methods for longitudinal and multilevel analyses, behavioral outcome research, and multimodal EEG/fMRI neuroimaging (increasing the depth and clinical generalizability of her research). Dr. Aupperle has assembled a team of mentors uniquely suited to provide the required diversity of expertise. Drs. Martin Paulus (LIBR Scientific Director and primary mentor) and Jim Abelson will provide expertise for integrating across neurobiological and clinical/behavioral levels of analyses. Dr. Michelle Craske will bring her extensive experience related to the development and investigation of behavioral interventions for anxiety. Dr. Bodurka, LIBR Neuroimaging Core Director, will provide mentorship related to simultaneous EEG/fMRI imaging. The training, and associated research, will take place at LIBR, a state-of-the-art institute dedicated to conducting neuroimaging and genetics research aimed at developing more effective treatments for neuropsychiatric disorders.
Anxiety disorders are the most common class of mental health disorders in the United States and generalized anxiety disorder (GAD) is the most common anxiety disorder presenting to primary care. The most effective treatments for GAD, including behavior therapies, lead to significant, long-lasting improvements for only 40- 60% of patients. The proposed study aims to identify brain and behavior responses that may be used to identify individuals who would benefit the most from a particular type of behavioral intervention, with the aim of informing the future treatment of GAD.
