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CompletedNCT02808702Updated Oct 31, 2022

Brain Correlates of Self-Focused Processing

An interventional study of Cognitive-behavioral therapy in Social Phobia and Body Dysmorphic Disorder, sponsored by Massachusetts General Hospital. Completed at 2 sites in United States. Open to participants aged 18 Years to 45 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2022-10-31.

Sponsored by Massachusetts General Hospital · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
89
Allocation
Not applicable
Ages
18 Years to 45 Years
Sex
All
01

Study summary

The purpose of this study is to determine whether neuroimaging-based markers of maladaptive self-focused processing are better predictors of treatment response to cognitive-behavioral therapy than behavioral markers.

Read the detailed description

First, the investigators propose to identify the neural correlates of self-focused processing. The investigators will assess baseline resting state connectivity within the default network, as well as regional brain activation using a well-validated event-related fMRI task that manipulates self-focused processing in patients with body dysmorphic and socially anxious symptoms, compared to healthy controls. This clinical sample was selected because such patients display heightened self-focused attention, and sampling individuals across these symptom dimensions will ensure greater variability on this dimension of maladaptive self-focused processing. Second, the investigators will examine the neural correlates of self-focused processing as a predictor of treatment response. Neuroimaging data will be acquired from patients with body dysmorphic and socially anxious symptoms during two scan sessions, before and after 12 weeks of individual cognitive behavioral therapy, and compared with healthy controls scanned twice at a 12 week interval. Finally, the investigators will compare the prediction of treatment response between neural measures and behavioral measures of self-focused processing. The investigators will assess the behavioral correlates of self-focused processing using a self-reference effect paradigm, and assess their relation to treatment response. If the investigators hypotheses are borne out, the investigators will have new targets for treatment, a method to identify promising candidates for treatment, and sensitive surrogate markers of treatment response.

02

Conditions studied

  • Social Phobia
  • Body Dysmorphic Disorder

Keywords

  • Attention
  • Cognitive behavioral therapy
  • Neuroimaging
03

Who can participate

Ages eligible
18 Years to 45 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • Men and women, age 18-45
  • For patients: treatment-seeking individuals presenting with at least moderate levels of social anxiety/body dysmorphic symptoms, and a score of at least 1 SD above the mean on the public self-consciousness scale of the Self-Consciousness Scale- Revised
  • For healthy controls only: no current or lifetime history of psychiatric disorders, and score of below 1 SD of mean on the SCS-R
  • Right-handed, as determined by the Handedness Inventory
  • Fluent in English, and willing to provide informed consent

Exclusion criteria

Exclusion Criteria:

  • Positive MR screen
  • History of head injury, neurological disorder, or neurosurgical procedure
  • Active suicidal or homicidal ideation
  • Current or past manic/hypomanic episode or psychotic symptoms
  • Active alcohol and substance dependence (as assessed by the SCID-5-RV
  • Current use of psychotropic medications, except antidepressants taken at a stable dose for 2 weeks, to maximize generalizability of sample
  • Current CBT and/or formal mindfulness/meditation training
  • History of more than 10 sessions of CBT and formal mindfulness/meditation training
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
89 participants (actual)

Study arms

  • Experimental
    Cognitive-behavioral therapy

    Twelve weekly sessions of individual cognitive-behavioral therapy

    Behavioral: Cognitive-behavioral therapy

Interventions

  • BehavioralCognitive-behavioral therapy

    Twelve weekly sessions of individual cognitive-behavioral therapy

05

What researchers measure

Primary outcomes

  1. Change from baseline clinical symptoms at 12 weeks

    Evidence of symptom improvement as determined by clinician-administered assessment of body dysmorphic and socially anxious symptoms

    Time frame: Baseline and 12 weeks from baseline

  2. Neural activation in the default mode network

    Difference in regional brain activation in the default mode network in the Self vs. Other contrast (specifically in the medial prefrontal cortex, temporoparietal junction, posterior cingulate) during fMRI activation paradigm

    Time frame: Baseline and 12 weeks later

  3. Resting state functional connectivity within the default mode network

    Functional connectivity within the default mode network during resting state scan

    Time frame: Baseline and 12 weeks later

  4. Response latencies during Self vs. Other conditions

    Difference in average response latencies (in ms) during Self and Other conditions of a self-referential processing task

    Time frame: Baseline and 12 weeks later

Secondary outcomes

  1. Word valence during Self vs. Other conditions

    Number of positive and negative words endorsed during Self and Other task conditions

    Time frame: Baseline and 12 weeks later

  2. Structural connectivity within the default mode network

    White matter connectivity within the default mode network during DTI scan

    Time frame: Baseline and 12 weeks later

06

Study locations

2 sites
  • Massachusetts General Hospital
    Boston, Massachusetts 02114, United States
  • University of Washington
    Seattle, Washington 98195, United States
07

References and documents

Publications

  • Fang A, Baran B, Beatty CC, Mosley J, Feusner JD, Phan KL, Wilhelm S, Manoach DS. Maladaptive self-focused attention and default mode network connectivity: a transdiagnostic investigation across social anxiety and body dysmorphic disorders. Soc Cogn Affect Neurosci. 2022 Jul 2;17(7):645-654. doi: 10.1093/scan/nsab130. PubMed 34875086 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT02808702
Lead sponsor
Massachusetts General Hospital
Responsible party
Angela Fang (Assistant Professor of Psychology, Massachusetts General Hospital) — Principal investigator
First posted
Jun 22, 2016
Start date
May 1, 2017
Primary completion
Mar 13, 2020
Completion
Mar 13, 2020
Last update
Oct 31, 2022

Study contacts

Angela Fang, Ph.D.
principal investigator · University of Washington

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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