Highlight: What Is a Target?
Children and adults with anxiety often preferentially visually attend (also known as attention bias) to a threatening image (snake image on left). Researchers are focusing on attention bias as the “target” of promising treatments for anxiety disorders.12 Attention Bias Modification Treatment trains individuals to more quickly disengage from threatening situations and, in doing so, alleviates anxiety stemming from the threat.
Investigators are also pursuing other approaches to assess and study attention bias. Using brain imaging, it is now known that attention bias is associated with abnormal function in a specific brain region called the ventral lateral cortex.13 Abnormal functioning within this region may be the reason why individuals have difficulty directing attention to useful behaviors following a threatening situation. In this context, the ventral lateral cortex can be considered a “target” for the development of novel anxiety-disorder treatments that augment attention control of individuals toward useful tasks.
Source: Image created by NIMH
The term “target” refers to a hypothesized mechanism of action and its ability to modify disease, behavior, or functional outcomes. Given the broad range of science that NIMH funds, “target” can refer not only to mechanisms within an individual patient, but also to external factors that impact mental health outcomes such as the attitudes and behaviors of health care providers, the influence of peers or family members, or characteristics of health care systems. Thus, targets can range from molecular- and circuit-level mechanisms proposed for pharmacologic agents, to neural systems, cognitive processes for psychosocial behaviors, or provider decision making, to organizational behaviors that are thought to underlie the benefits of a psychosocial- or service-level intervention.
The basis of experimental medicine is the assumption that modification of the target will result in improvement of symptoms, behavior, or functional outcomes. A good target at the individual level should be strongly associated with a clinical symptom or functional deficit, and evidence should strongly suggest that the target impacts a psychological or biological pathway through which a clinical or functional benefit occurs (see figure). In the case of services interventions, an intervention may target the patient (e.g., adherence), the provider (e.g., fidelity in the delivery of research-supported pharmacologic or psychosocial interventions), or the system/organization (e.g., organization climate, readiness to adopt evidence-based practices) in the service of improving access, engagement, or quality of mental health services. The demonstrated success of the experimental medicine approach in other areas of medicine, such as cancer and diabetes, has depended on the research community’s ability to identify and demonstrate engagement of targets. This will be equally true for mental health research taking place at all scales, from individual research projects to large-scale trials.
Highlight from Introduction