PROJECT SUMMARY/ABSTRACT This K23 proposal seeks to further the career of Dr. Stefanie Russman Block through a mentored research project and training plan that focuses on innovative neuroimaging methods and a theoretical framework of emotion dysregulation applied to anxiety disorders. Anxiety disorders are the most prevalent mental health condition worldwide and disproportionately affect young adults (age 18-24). Despite the existence of evidenced-based treatments, remission rates are low. Cognitive reappraisal (CR), a core therapeutic skill that involves changing the meaning of a situation (e.g., threatening) to alter its emotional content (i.e., lower anxiety), relies on the left ventrolateral prefrontal cortex (vlPFC), which continues to mature until age 25, and is underrecruited in anxiety patients compared to healthy participants. Real-time functional magnetic resonance imaging neurofeedback (NF), which teaches volitional control over targeted brain activity, may offer a novel approach to engage the vlPFC during CR, thereby improving the effectiveness of emotion regulation and reducing anxiety. In the proposed K23, young adults with elevated anxiety (N = 88) will be randomized to NF targeted at the vlPFC or sham NF while performing the Emotion Regulation Task. Participants will be instructed to reappraise the meaning of negative images to reduce their emotional impact or to look at them passively. After each trial, participants are presented with a thermometer displaying neural activity from the reappraise > look contrast. The sham group views pseudo-random feedback, generated to match the spectral characteristics and average success rate of veritable feedback. After each run, participants rate their negative affect on a visual analog scale. The specific research aims are to: 1) Evaluate the ability of young adults with anxiety to increase vlPFC activity during CR based on NF by comparing the increase in neural activity pre to post training; 2) Determine the relationship between vlPFC recruitment and CR success using the reduction in negative affective ratings compared to passive viewing pre to post training; and 3) Assess the impact of NF on anxiety symptoms over time (exploratory). This K23 project will help define a treatment target and provide pilot data for a future R-level grant. The following training objectives will ensure that Dr. Russman Block successfully achieves these aims and is equipped to become an independent researcher: 1) acquire skills in the design, implementation, and analysis of NF research; 2) gain expertise in the affective neuroscience of emotion regulation; and 3) obtain training in experimental therapeutics, including the design, conduct and analysis of randomized clinical trials. These training objectives will provide the necessary foundation for her long-term career goals of becoming an independent, extramurally-funded, clinical-translational researcher, whose research will seek to understand neural processes in...