Cognitive Reappraisal Training Targeting Emotion Circuits As a Therapeutic Intervention in Borderline Patients

针对情绪回路的认知重评训练作为边缘患者的治疗干预

基本信息

批准号：
10286406
负责人：
Harold W Koenigsberg
金额：
$ 98.08万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10286406
关键词：
Address Adherence Affect Affective Amygdaloid structure Anger Aversive Stimulus Behavioral Borderline Personality Disorder Brain Chronic Clinical Cognitive Consumption Development Disease Dose Educational Intervention Effectiveness Emotional Emotions Event Evidence based treatment Exposure to Functional Magnetic Resonance Imaging Health Resources Healthcare Image Impairment Impulsivity Intervention Lead Life Manuals Measures Mental Health Mental disorders Methods Moods Outcome Patients Performance Pharmaceutical Preparations Phase Population Prevalence Psychotherapy Reaction Regulation Reporting Reproducibility Research Resistance Resources Role Sampling Severities Stimulus Suicide Symptoms System Testing Therapeutic Intervention Time Training Training Programs Translating Work associated symptom base behavior measurement behavioral response care burden clinical outcome measures clinically relevant cognitive enhancement cognitive reappraisal cognitive training cost design disabling symptom dosage emotion dysregulation emotion regulation emotional experience experience follow-up functional outcomes health care service improved innovation interest loved ones neural circuit neural network neuroregulation novel strategies perceived stress psychosocial reduce symptoms relating to nervous system response social success suicidal risk suicide rate treatment effect treatment optimization

项目摘要

Project Summary/Abstract Borderline Personality Disorder (BPD) is a prevalent, enduring and disabling psychiatric condition found in approximately 2% to 5.9% of the population [1, 2] and 20% of hospitalized psychiatric patients. Suicide rates of approximately 10% have been reported [3]. One of the most prominent clinical features of BPD is extreme mood shifts [4-6] occurring in response to external social/emotional events [7-9]. The emotional instability in BPD contributes to many of the most disabling, even life-threatening, symptoms of the disorder, including suicidality, outbursts of intense anger, and seriously impaired role functioning [10]. The severity of the BPD symptom profile, its prevalence, chronicity and high burden upon health care services [11-13] make the development of effective and accessible treatment for BPD a high priority. Yet there is no current medication treatment indicated for BPD and the psychotherapies recognized for the disorder have been shown to have small effect sizes and are of limited availability. The present study builds upon work by our group that has shown that deficiencies in the ability to regulate emotion by engaging typically adaptive cognitive strategies (cognitive reappraisal, CR) and to effectively activate associated neural systems can be corrected by focused training in CR. The R61 phase of this study examines a manualized intensive training program in CR, tests that it effects target neural systems implicated in emotional processing and enhances behavioral reappraisal success. It examines 2-, 4- and 6- weeks of twice a week treatment to identify the optimal dose. Measures include fMRI imaging and clinical ratings at baseline and each of these subsequent time points. Upon demonstrating that CR training is superior to a control condition in enhancing performance in the neural target at one or more of these dose durations, we will proceed to the R33 phase. In the R33 phase we will treat a larger sample of BPD patients at the optimal dose defined in the R61 phase to 1) demonstrate reproducibility of the R61 findings, 2) to demonstrate that CR training is superior to control in improving BPD clinical outcomes at the end of treatment and at 1- and 4- month follow-up, and 3) that change in activity at the neural targets is associated with clinical improvement. The results of this study can support the introduction of CR training as a new psychosocial approach for the treatment of BPD, either as stand-alone treatment or as an augmenting strategy. It may, moreover, have application to a range of psychiatric disorders characterized by severe emotional instability.

项目概要/摘要边缘性人格障碍 (BPD) 是一种普遍存在、持久且致残的精神疾病大约有 2% 至 5.9% 的人口 [1, 2] 和 20% 的住院精神病患者患有此病。自杀据报道，这一比例约为 10% [3]。 BPD 最突出的临床特征之一是因外部社交/情绪事件而发生的极端情绪变化 [4-6] [7-9]。情绪化的 BPD 的不稳定会导致许多最严重的致残、甚至危及生命的症状，包括自杀、强烈愤怒的爆发和角色功能严重受损[10]。严重程度 BPD 症状特征、其患病率、长期性以及医疗保健服务的高负担 [11-13] 使得开发有效且易于获得的 BPD 治疗方法是当务之急。但目前尚无药物针对 BPD 的治疗和公认的针对该疾病的心理疗法已被证明具有效应较小且可用性有限。本研究建立在我们小组的工作基础上，该工作表明，能力的缺陷通过采用典型的适应性认知策略（认知重评，CR）来调节情绪有效激活相关神经系统可以通过CR集中训练来纠正。 R61相这项研究检验了 CR 的手动强化训练计划，测试它对目标神经系统的影响参与情绪处理并提高行为重新评估的成功率。它检查 2-、4- 和 6- 每周治疗两次以确定最佳剂量。措施包括功能磁共振成像和临床基线和每个后续时间点的评分。在证明 CR 培训优越之后对于在一个或多个这些剂量持续时间内增强神经靶标性能的控制条件，我们将进入R33阶段。在 R33 阶段，我们将以 R61 中定义的最佳剂量治疗更大样本的 BPD 患者阶段 1) 证明 R61 结果的可重复性，2) 证明 CR 训练优于在治疗结束时以及 1 个月和 4 个月随访时控制改善 BPD 临床结果，以及 3) 神经目标活动的变化与临床改善相关。这项研究的结果可以支持将 CR 培训作为一种新的心理社会方法引入 BPD 的治疗，无论是作为独立治疗还是作为增强策略。此外，它可能还具有适用于一系列以严重情绪不稳定为特征的精神疾病。