Advance-CTR Pilot Projects Program (2016)
"Brain/Behavior Mechanisms of Emotion Dysregulation in Adolescents with Mood and Anxiety Disorders (MAD)"
Co-PI: Kunal Mankodiya, PhD
Emotion dysregulation (ED) is a broad risk factor for psychopathology and maladaptive outcomes. Left untreated, adolescent ED is linked to serious behaviors like suicide, which despite research, policy, and clinical efforts, is the 2nd leading cause of death among 13-18 year olds. This statistic holds true nationally but also locally in Rhode Island, where 100+ young people ages 10-24 died by suicide from 2008-2015. As such, NIMH has highlighted the need for identifying bio/behavioral predictors of suicide. Toward this, the broad objective for this RI-CCTS pilot project is to address this call through a unique collaboration between Bradley Hospital, Brown University’s MRI Research Facility, and the University of Rhode Island. Specific aims: (1) To define baseline pre-dialectical behavior therapy (DBT) functional MRI neural and real- world psycho-physiological alterations (i.e., heart rate variability, galvanic kin response) in ED among 13-18 year-old females with Mood and/or Anxiety disorder plus impairing Dysregulation (MAD) vs. healthy controls (HC) (n=10 per group); and (2) to test how an existing psychosocial treatment (i.e., DBT) perturbs the fMRI neural and real-world psycho-physiology associated with ED among MAD. Central hypotheses: Compared to HC, MAD will have (a) neural alterations in a prefrontlal cortex-amygdala -striatal circuit (including anterior cingulate cortex and nucleus accumbens) during distress tolerance and interpersonal conflict tasks, (b) normalized circuit function post-DBT, and (c) aberrant ED via HRV and GSR in ecologically-valid settings that will normalize post-DBT. This study is innovative and significant as it is the first to take NIMH’s Research Domain Criteria (RDoC) multi-level of analysis approach to not only probe the fMRI neural and real-world psycho-physiological alterations underlying ED in MAD adolescents vs. HC, but also to test how these biological measures of ED are altered via a treatment (DBT) that, while helpful clinically, the mechanism remains unknown. We will address this goal via a unique collaboration between Kerri Kim, Ph.D. (Bradley, expertise psychopathology and treatment), Daniel Dickstein, M.D. (Bradley, expertise in neuroimaging), and Kunal Mankodia, Ph.D. (URI, expertise in biomedical engineering and wearable sensors to collect real world ecologically-valid physiological data). This RI-CCTS pilot project will generate vital pilot data for both NIH/NIMH R01, NSF, and American Foundation for Suicide Prevention (AFSP) grant submissions on the high-priority area of mechanisms of ED and youth suicide, wearable sensors, and bio- informatics relating peripheral physiological markers of ED (HRV, GSR) to fMRI neuroimaging.