Neurocircuitry and Treatment Targets

Neurocircuitry and Treatment Targets translates network science into everyday treatment choices—how to pick levers that nudge the right circuits for anxiety, depression, psychosis, and substance use disorders. We summarize four workhorse networks—salience, default mode, central executive, and limbic reward—and connect symptoms to plausible targets with or without advanced tech. If you’re designing a track at a treatment targets in psychiatry conference, you’ll find “no-scan” pathways that pair psychotherapy modules (exposure/ERP, behavioral activation, MI/CBT-SUD) with sleep and activity timing to prime plasticity, plus guidance for when to consider TMS/ECT and how to communicate realistic expectations. We emphasize plain-language explanations so patients understand why a plan fits their pattern, making adherence sturdier. For biomarker and scanner considerations, see Imaging Biomarkers in SUD.

Targets only matter if clinics can reach them. We outline stepwise algorithms that start with high-yield basics—circadian anchors, cue control, graded exposure, activation—and then layer medications chosen by mechanism and tolerability. Neuromodulation pathways specify symptom-to-target links, safety screens, and coordination with psychotherapy so gains consolidate. Equity shapes access: where imaging or devices are scarce, teams use behavioral proxies (sleep metrics, craving diaries, attention tasks) to personalize care. Dashboards track function, sleep, cravings, and safety; thresholds trigger augmentation or switch steps without months of drift. Finally, we link targets to identity and roles—work, caregiving, study—so improvements translate into life that feels worth protecting. The aim is not a perfect scan; it’s a plan patients can live with that steadily improves capacity and connection.

Networks and First Levers

Salience/Threat

  • Overweighted danger signals drive avoidance.
  • Use exposure/ERP with mindfulness and breath pacing.

Default Mode

  • Rumination crowds out present-focused action.
  • Behavioral activation and values work re-engage life.

Central Executive

  • Fatigue and distraction erode planning.
  • Implementation intentions and environment design help.

Reward

  • Anhedonia blunts pursuit of good routines.
  • Schedule activation, social rewards, and exercise.

Tools, Access, and Quality

Sleep and circadian
Morning light, fixed wake time, and evening wind-down.

Medications
Choose by mechanism and side-effect fit; avoid stacking.

Neuromodulation
Clear indications, safety screens, and consolidation plans.

Digital supports
Privacy-aware prompts for skills and routines.

Behavioral proxies
Sleep and craving metrics substitute when scans aren’t available.

Equity features
Interpreters, tele/phone options, and transport help.

Dashboards
Function and safety guide step-ups or step-downs.

Learning health system
PDSA cycles turn insight into durable practice.

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