Blunted and Discordant Affect: A Transdiagnostic Construct in Psychopatholog

钝化和不一致的情感：精神病理学中的跨诊断结构

基本信息

批准号：
8250515
负责人：
Wendy Michelle D'Andrea
金额：
$ 70.88万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8250515
关键词：
Address Affect Affective Amygdaloid structure Anhedonia Anxiety Anxiety Disorders Awareness Borderline Personality Disorder Categories Child Abuse Chronic Clinical Conscious Cues Data Diagnosis Diagnostic Dimensions Disease Dissociation Emotional Emotions Event Exposure to Failure Functional Magnetic Resonance Imaging Future Individual Lead Literature Measures Mental Depression Methods Nature Participant Patient Self-Report Patients Peripheral Physiological Physiology Post-Traumatic Stress Disorders Prevalence Process Psychopathology Pupil Reaction Recording of previous events Repression Research Sensory Side Specificity Stimulus Survivors Syndrome Testing Time Trauma Treatment outcome Work clinically relevant common treatment conventional therapy coping distraction effective therapy emotional stimulus experience gaze improved indexing instrument neuroimaging neuromechanism relating to nervous system response theories therapy development trait vigilance

项目摘要

DESCRIPTION (provided by applicant): We propose to assess the validity of a blunted and discordant affect (BADA) construct in multiply- symptomatic pan-diagnostic individuals stratified on abuse history and diagnosis, compared to healthy individuals. Common treatments for depression, anxiety, Post-Traumatic Stress Disorder (PTSD), and Borderline personality disorder (BPD), which are typically effective for up to 40-60% of patients, work to reduce high affective intensity and reactivity, e.g., hyperarousal, irritability, or threat sensitivity. The opposite pole, involving blunted and discordant affective responses, is frequently described by clinicians, e.g., as "shutting down", but is rarely researched, and is not as explicitly addressed in common treatments. Clinicians particularly note these features in survivors of chronic childhood abuse, who often have affective psychopathologies. Improved understanding of this construct, including its prevalence, mechanisms, and differentiation from affective hyper-reactivity, could lead to specialized and effective treatment for individuals characterized by it. We will examine this construct via affect-rating, physiological, and neuroimaging during conventional tasks and tasks that approximate conditions in which functional deficits are observed in 150 patients with depression, anxiety, PTSD, and Borderline Personality Disorder as well as 50 healthy participants. Primary aims, will be to examine: 1) Construct validity-the magnitude, time course, and neural mechanisms of blunted and discordant affect, 2) Concurrent validity-relationships of the assessed measures of blunted and discordant affect with self-reported trait coping and affect constructs such as such as dissociation, numbing, repression, suppression, distraction, avoidance, and discordant attachment. This aim puts the construct in the context of the broader similar literature, and 3) External validity-specificity of observed constructs with respect to abuse history, diagnostic category, hyper-reactivity, valence, and functioning. This aim characterizes the generalizability of the construct with regard to whether it is a dimension or syndrome, trauma history, axis I and II diagnoses, valence specificity, and functioning. Positive results could suggest it is necessary to abandon the practice of averaging self-report, physiological, and neuroimaging data across patients and instead assess both hyper- and hypo-reactivity as important to psychopathology. Next steps would entail examining whether these poles are differentially associated with treatment outcome in conventional treatments and development of treatments to target both hyper- and hypo-reactivity. PUBLIC HEALTH RELEVANCE: Common mechanistic theories of and treatments for depression and anxiety disorders regard hyper-reactivity to emotional information. We propose to show that the opposite poles, blunted emotional responses, are common and clinically meaningful. We further propose to show that this phenomenon is related to early traumatic experiences. Positive results would suggest that averaging data across patients with a disorder is misleading as increased and decreased reactions could average out to hide problems on both sides of the spectrum. Rather, we will demonstrate methods for more sensitive assessments of this phenomenon.

描述（由申请人提供）：我们建议与健康个体相比，评估根据滥用史和诊断分层的多症状泛诊断个体中钝化和不一致情感（BADA）构建的有效性。抑郁症、焦虑症、创伤后应激障碍 (PTSD) 和边缘性人格障碍 (BPD) 的常见治疗通常对高达 40-60% 的患者有效，可降低高情感强度和反应性，例如过度警觉、烦躁或威胁敏感性。相反的一极，涉及迟钝和不一致的情感反应，经常被临床医生描述为“关闭”，但很少进行研究，并且在常见治疗中没有明确解决。临床医生特别注意到长期儿童虐待幸存者的这些特征，他们往往患有情感精神病理学。更好地了解这种结构，包括其普遍性、机制以及与情感过度反应的区别，可以为具有这种结构的个体提供专门且有效的治疗。我们将在常规任务和近似条件的任务中通过情感评级、生理学和神经影像学来检查这一结构，在 150 名患有抑郁症、焦虑症、创伤后应激障碍和边缘性人格障碍的患者以及 50 名健康参与者中观察到功能缺陷。主要目标是检查：1）构建有效性——钝化和不一致情感的幅度、时间过程和神经机制，2）并行有效性——所评估的钝化和不一致情感测量与自我报告的特质应对和影响诸如解离、麻木、压抑、抑制、分心、回避和不和谐依恋等结构。这一目标将构建置于更广泛的相似文献的背景下，并且3）观察到的构建在滥用历史、诊断类别、过度反应性、效价和功能方面的外部有效性-特异性。这一目标表征了该结构的普遍性，无论是维度还是综合征、创伤史、轴 I 和 II 诊断、效价特异性和功能。积极的结果可能表明有必要放弃对患者的自我报告、生理和神经影像数据进行平均的做法，而是评估对精神病理学很重要的高反应性和低反应性。下一步将需要检查这些极点是否与传统治疗中的治疗结果存在差异相关，并开发针对高反应性和低反应性的治疗方法。公共卫生相关性：抑郁症和焦虑症的常见机制理论和治疗方法涉及对情绪信息的过度反应。我们建议证明相反的两极，即情绪反应迟钝，是常见的且具有临床意义。我们进一步建议表明这种现象与早期的创伤经历有关。积极的结果表明，对患有疾病的患者进行平均数据具有误导性，因为增加和减少的反应可能会平均起来，从而掩盖了谱系两侧的问题。相反，我们将展示对这种现象进行更敏感评估的方法。