This center grant, in response to the CIDAR RFA, proposes to study neurobehavioral and social correlates of treatment response in 200 youth (ages 9-13) with anxiety disorders (separation anxiety, generalized anxiety disorder, and/or social phobia). All youth will receive 10 weeks of CBT for child anxiety disorders and half will also receive a multicomponent intervention to enhance sleep. The studies combines state-of-the-art measures from affective neuroscience, ecologically valid (EMA) measures of mood, sleep, and behavior in natural environments, and measures of family and social context within a developmental framed treatment study. The study design focuses on predictors and mechanisms of treatment response. The structure includes four projects and three cores. Project 1: Cognitive and Affective Features of Childhood and Adolescent Anxiety: From Brain Mechanisms to Recovery will test key features of a """"""""vigilance-avoidance"""""""" model focusing on hypotheses that pre-treatment neural correlates of affective reactivity will predict treatment response and early changes in emotional processing will correlate with clinical response during treatment. Project 2: Effects of Sleep Enhancement on Affective Functioning provides a multicomponent sleep intervention to half of the youth to test hypotheses that anxious youth who show sleep improvements will have a more positive and sustained trajectory of improvements in anxiety and social function. Project 3: A Social Contextual Analysis of Treatment Response to CBT for Youth Anxiety examines how affective experiences within the family and social context are associated with treatment response and change across treatment, and how these are associated with and interact with neurobehaviroral changes in affective functioning. Project 4: Moderators and Mediators of Anxiety and Related Health Outcomes Following CBT Treatment examines anxiety and linked health outcomes (e.g. depression and substance use) longitudinally in anxious youth following treatment and examines the relationship of course to specific genetic polymorphisms and environmental stressors. Taken together these studies will advance understanding of the neurobehavioral, affective, and social processes that underpin treatment response in ways that will inform the design, refinement, and optimal developmental timing of cognitive behavioral treatments, and thus, decrease the morbidity, mortality, and lifetime impairments from these common disorders in youth.
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