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ERC

INTERACT Report Summary

Project ID: 309767
Funded under: FP7-IDEAS-ERC
Country: Belgium

Mid-Term Report Summary - INTERACT (Counteracting psychosis by optimizing interaction)

The INTERACT project aims to investigate an entirely novel real-time and real-world intervention for psychosis, one of the most severe psychiatric syndromes. With this therapy, we are targeting the core vulnerability profile of altered stress-reactivity and reward mechanisms in individuals with psychotic symptoms. Furthermore, we aim to use an experimental neuroscience approach to investigate the neural effects of this real-time intervention, examining the impact in terms of brain plasticity and prediction of response.

We first examined the role of social stress and social reward in eliciting differential prefrontal dopaminergic reactivity in subjects with psychosis and at genetic risk for psychosis compared to controls, using a PET imaging approach. Furthermore, we used the Experience Sampling Method, a structured diary technique, in the same participants to elucidate stress and reward mechanisms in real life. We examined 15 healthy control subjects and 15 unmedicated patients with psychosis with the Montreal Imaging Stress Task in a [18F]fallypride PET paradigm. We found stress to be associated with increased dopaminergic activity in the medial prefrontal cortex. However, in contrast with our hypothesis, no differences were found between patients and control subjects. Interestingly, when combining the PET neuro-imaging data with ESM, we found prefrontal dopamine to mediate the psychotic reactivity to stress in real life.

For the study of reward mechanisms, we developed a “social” version of the Probabilistic Stimulus Selection Task, a task measuring reward learning and reward sensitivity. We studied 17 healthy relatives of patients with a psychotic disorder, 11 non-psychotic subjects with a 22q11 deletion syndrome, and 17 healthy volunteers again with a [18F]fallypride PET paradigm. Preliminary data suggest that social reward is associated with a significant increase in dopamine release in subcortical and cortical regions of healthy individuals and unaffected siblings of individuals with psychosis. The magnitude of dopamine release is positively associated with performance on the social reward task. Furthermore, performance on the task is also positively associated with experience of reward in the daily life.

Additionally, we developed the Acceptance and Commitment Therapy in Daily Life (ACTdl). ACTdl is a mobile Health treatment protocol for Acceptance and Commitment Therapy. By using mobile technology, we are bridging the gap between the therapist’s office and the real world. With ACTdl, we aim to increase ACT’s therapeutic effectiveness through improved integration of its therapeutic techniques into the patient’s everyday-life. The ACTdl consists of two main components; daily monitoring using Experience Sampling and ACT training in patients’ daily life environment. Acceptability and feasibility were tested in a convenience sample of 49 psychiatric patients. We are now starting an RCT examining the effectiveness of ACTdl in patients at Ultra-High risk for psychosis, in comparison to either Treatment as Usual or Cognitive Behavioral Therapy for Psychosis.

In order to examine the neural effects of ACTdl, we will apply an fMRI paradigm examining stress and reward mechanisms pre- and post-treatment. We have conducted several pilots in preparation of this study. First, we investigated the effects of social stress on reward sensitivity by inducing social stress in a laboratory experiment in 47 healthy volunteers and we investigated the same association in an Experience Sampling study. Both studies converged on the deleterious effects of social stress on hedonic capacity and reward sensitivity, in the laboratory as well as in daily-life. Second, we developed a milder, “social” version of the Montreal Imaging Stress Task, which can be applied twice without debriefing after the first application, thereby retaining its credibility. We tested this in 30 healthy volunteers and found no difference in the increase in stress experience and heart rate in the first and the second session, suggesting that the task remains stressful when administered on a second occasion. Furthermore, we piloted both the adjusted MIST in an fMRI paradigm in 10 healthy volunteers, demonstrating feasibility of the approach in a scanner environment. This approach will be employed pre- and post-ACTdl therapy in the participants at Ultra High Risk for psychosis.

Contact

Stijn Delaure, (Head of International Funds)
Tel.: +3216 32 09 44
E-mail
Record Number: 191536 / Last updated on: 2016-11-21