Correlates of Anxiety Associated With a Life-threatening Illness

Diagnosis of, and living with a life-threatening illness can result in symptoms similar to those seen in Posttraumatic Stress Disorder (PTSD), and these symptoms may persist even if the individual recovers, or their illness goes into remission. These symptoms may include emotional avoidance and numbing, difficulty relating to or connecting with friends or loved ones, difficulty sleeping, a sense of foreshortened future, and intrusive thoughts or memories related to the illness. These symptoms are an additional burden for the individual experiencing them and for their caretakers, and reduces quality of life.

Methylenedioxymethamphetamine (MDMA)-assisted psychotherapy is an experimental treatment for anxiety disorders, and initial findings suggest that it holds promise for treatment of PTSD. This study will examine brain activity in participants enrolled in an investigation of the safety and efficacy of MDMA-assisted psychotherapy in people with anxiety stemming from diagnosis with a life-threatening illness to see whether MDMA-assisted psychotherapy alters emotional reactivity to anxiety-provoking material, including positive and negative images. The study will also examine brain activity related to the experience of self-compassion/empathy in response to personalized audio scripts, and whether that response is altered by MDMA-assisted psychotherapy. Brain imaging may offer a measure of neural markers of anxiety and self-compassion that do not rely on self-report.

A subset of participants in the study "Randomized, Double-Blind, Placebo-Controlled Phase 2 Pilot Study of MDMA-Assisted Psychotherapy for Anxiety Associated with a Life-Threatening Illness" (NCT02427568) without any contraindicating factors for brain imaging will undergo three fMRI scans as part of this observational study. The first scan will occur prior to experimental sessions and a second scan will occur after two experimental sessions of MDMA or placebo-assisted psychotherapy. Participants will then be scanned a third time after they have completed a total of three sessions of MDMA-assisted psychotherapy (this includes both subjects that are originally in the MDMA-assisted psychotherapy group, as well as the subjects in the placebo group who will cross over and complete three active MDMA-assisted psychotherapy sessions subsequent to their placebo-assisted psychotherapy. The primary endpoint will be the scan after the second session of MDMA-assisted psychotherapy.

During each scanning session, participants will be undergoing brain scans with functional magnetic imaging (fMRI) while they perform an emotional regulation task that involves observing images possessing negative emotional valence. These images are drawn from, and have their emotional valence validated by, the International Affective Picture System (IAPS). Participants are instructed either to view passively or attempt to reduce the negative affect associated with the images. In addition, resting state brain scans will also be acquired while subjects fixate on a central cross with no explicit task. Heart rate variability will be measured during these resting state scans. The comparison of changes in brain activity during execution of the emotional regulation task (as compared to baseline scans) after receiving psychotherapy with MDMA or placebo, as well as comparison of changes in resting state functional connectivity, are the primary outcome measures. Study observations are intended to assess changes in response to emotion-provoking material at several levels, most notably brain activity in response to anxiety producing images.

While in the scanner, subjects will also listen to prerecorded audio scripts about life stresses for themselves and for another person with instructions to practice compassion for themselves or for others. In yet another task, subjects will perform an attentional bias task where they respond to a dot-probe that appears following a brief presentation of paired images known to produce positive and negative emotions as their brain activity is measured and their reaction times are recorded