Exposure therapy for pediatric irritability: Theory and potential mechanisms
Exposure therapy for pediatric irritability: Theory and potential mechanisms
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DOI：
10.1016/j.brat.2019.04.007
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发表时间：
2019-07-01
影响因子：
4.1
通讯作者：
Brotman, Melissa A.
中科院分区：
文献类型：
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作者：
Kircanski, Katharina;Craske, Michelle G.;Brotman, Melissa A.
小儿易激惹是普遍存在的，损害，但很少有人知道其病理生理和治疗。在这篇文章中，我们建立在我们和其他人以前的工作，以揭示在大脑，行为和环境中运作的易怒的核心机制。具体来说，我们提出了近端的过程，周围的神经病学的易怒，是潜在的目标，为一个基于认知行为疗法（CRT）的易怒，我们的小组已经开发。该模型的核心集中在神经认知过程：青少年对非奖励和威胁刺激的编码，这涉及大脑中的预测错误信号，以及挫折背景下的认知控制。理论上，这些过程的改变是慢性严重易怒的核心。环境对青少年症状表达的反应也进行了研究。暴露为基础的CBT易怒利用控制，在体内暴露于非奖励和威胁刺激，目的是从事认知控制和目标自上而下的调节挫折。这种干预整合了选定的家长管理培训技术，以针对症状强化过程。持续的易怒的病理生理学和治疗研究不仅将完善我们对表型的新认识，而且还将为CBT疗效的大脑和行为机制提供更广泛的问题。
Pediatric irritability is prevalent and impairing, yet little is known about its pathophysiology and treatment. In this article, we build on our and others' previous work to posit core mechanisms of irritability operating across the brain, behavior, and environment. Specifically, we propose proximal processes that surround the symptomatology of irritability and are potential targets for an exposure-based cognitive-behavioral therapy (CRT) for irritability that our group has developed. The heart of this model focuses on neurocognitive processes: youth's encoding of nonreward and threat stimuli, which involves prediction error signaling in the brain, and cognitive control in the context of frustration. Alterations in these processes are theorized to be central to chronic, severe irritability. Environmental responses to youths symptom expression are also examined. Exposure-based CBT for irritability utilizes controlled, in vivo exposure to nonreward and threat stimuli with the aim to engage cognitive control and target top-down regulation of frustration. This intervention integrates selected parent management training techniques to target symptom reinforcement processes. Continued pathophysiological and treatment studies of irritability will not only refine our emerging understanding of the phenotype, but also inform broader questions on the brain and behavioral mechanisms of CBT efficacy.