Phobia clinical trials at UC Health
2 in progress, 1 open to eligible people
open to eligible people ages 18-65
Specific phobias and other anxiety disorders, such as post-traumatic stress disorder (PTSD), 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 extinction while eliminating a primary cause of attrition. Because such treatment happens directly in the brain, the investigators further hypothesize that the behavior outcomes may generalize particularly well to different contexts beyond the treatment period, and this approach, if successful, may be extended to treatments for posttraumatic stress disorder (PTSD) and other mental disorders.The objective of this 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. The Specific Aims of the R61 Phase are to: (1) confirm that our method engages the neurobiological target (amygdala reactivity to images of a feared object) in a population of individuals with specific phobia; and (2) to determine dosage-response optimization. The R61 Phase will confirm engagement of amygdala reactivity to fearful stimuli by our intervention method in patients suffering from phobia of everyday objects and animals (e.g., spiders). Varying the number of neuro reinforcement sessions across different subject groups (3 groups of 10 subjects each) and measuring reductions in the amygdala reactivity will demonstrate the robustness and mechanisms of target engagement. This will also enable assessment of the optimal dosage required to balance between maximal target engagement and imaging costs, in order to inform later studies. Our primary hypotheses are: i) our proposed intervention method will lead to significant reduction in fear to feared objects, via influence of the neurobiological target (amygdala reactivity, as measured by fMRI) at a suitable dosage level, this method can be successfully applied to patients suffering from phobias of everyday objects (e.g., spiders, syringes), to reduce clinically relevant fear measures.
Sorry, not yet accepting patients
Spider phobia is an exceedingly common phobia throughout the world. The current standard treatment involves exposure therapy, which consists of a series of brief exposures of an individual to the thing they fear, in this case spiders. This study aims to examine the use of a neuromodulatory technology, transcranial magnetic stimulation (TMS), as a possible treatment option for spider phobia. TMS uses low-intensity electromagnetic energy to stimulate the brain, introducing energy into critical hubs of brain networks to "reset" their function and alleviate symptoms with very few side-effects. This study will consist of four separate visits. After screening subjects for spider phobia, baseline testing of subjective distress measures and physiologic stress data (heart rate variability and sweat response) during a prolonged spider exposure test will be collected. Subjects will then be placed into one of two groups: one receiving exposure therapy and intermittent Theta Burst Stimulation (iTBS) TMS (active study group), and another receiving exposure therapy with iTBS to a circuit not involved in a phobic reaction (control study group). Subjects will undergo their first treatment session during the first visit following the baseline data collection; the second and third treatments will occur the following two days. The fourth visit will occur one week after the third and consist of the same testing as the first visit; the same data will be collected. Changes from pre- to post-treatment in both subjective and physiologic data will be compared between the treatment and sham groups to examine effects of TMS on spider phobia.