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Hypersensitivity to Social Threat, Anger, and Aggression in BPD

BPD 对社会威胁、愤怒和攻击性过度敏感

基本信息

批准号：
206463034
负责人：
Professorin Dr. Katja Bertsch, Ph.D.
金额：
--
依托单位：
Klinik für Allgemeine Psychiatrie
依托单位国家：
德国
项目类别：
Clinical Research Units
财政年份：
2011
资助国家：
德国
起止时间：
2010-12-31 至 2018-12-31
项目状态：
已结题

来源：
https://gepris.dfg.de/gepris/projekt/206463034?language=en
关键词：
Hypersensitivity Social Threat Anger Aggression

项目摘要

Aggression is highly prevalent in borderline personality disorder (BPD) and causes not only an immense burden for the individual patient, but also for society raising urgent questions about effective treatments. Data collected in the first funding period (supplemented by data from other groups) suggest five behavioral and neurobiological mechanisms which may mediate reactive aggression in BPD: (1.) threat hypersensitivity resp. attentional threat bias, (2.) maladaptive anger regulation, (3.) a tendency to rather approach than avoid social threat, (4.) deficits in cognitive empathy, and (5.) enhanced emotional simulation. These suggested biobehavioral mechanisms offer a promising starting point for the selection of treatment targets and for specifying the processes needed for change. Following the RDoC approach, we therefore intend to develop a new treatment to reduce aggression in BPD in the second funding period that targets the identified dimensions of neurobiology and observable behavior suggested to mediate reactive aggression in BPD. We plan to compose a symptom-oriented, mechanism-based group psychotherapy selecting techniques from evidence-based treatment programs for BPD. We will (1.) test the effects of this Mechanism-based Anti-Aggression Psychotherapy (MAAP) against a Non- Specific Supportive Psychotherapy (NSSP) in a randomized controlled trial with severity of aggressive behaviors as the primary outcome (measured with the change-sensitive Overt Aggression Scale - Modified (OAS-M)) assessed over a six-week period after finalizing the trial. Treatment effects will also be assessed at 6 months follow-up. (2.) We will validate the biobehavioral mechanisms as processes responsible for change in aggression of patients with BPD. The highly focused psychotherapy will allow a cost-effective intervention and might support current efforts in psychiatry to develop mechanism-based treatments in the future.

攻击性在交界性人格障碍(BPD)中非常普遍，不仅给患者个人造成巨大负担，也给社会带来了有效治疗的紧迫问题。在第一个资助期收集的数据(补充自其他小组的数据)提出了可能调节BPD反应性攻击的五种行为和神经生物学机制：(1)威胁过敏症。注意威胁偏向，(2)适应不良愤怒调节，(3)倾向于接近而不是避免社会威胁，(4)认知移情缺陷，以及(5)增强的情感模拟。这些建议的生物行为机制为选择治疗目标和指定改变所需的过程提供了一个有希望的起点。因此，根据RDoC的方法，我们打算在第二个资助期开发一种新的治疗方法，以减少BPD的攻击性，目标是确定的神经生物学维度和建议用于调节BPD反应性攻击的可观察行为。我们计划组成一个以症状为导向，以机制为基础的团体心理治疗，从BPD的循证治疗计划中选择技术。我们将(1.)在一项随机对照试验中测试这种基于机制的抗攻击心理疗法(MAAP)与非特异性支持性心理疗法(NSSP)的效果，并以攻击行为的严重程度为主要结果(使用修改后的变化敏感型公开攻击量表(OAS-M)进行评估)，在最终试验结束后的六周内进行评估。治疗效果也将在6个月的随访中进行评估。(2)我们将验证生物行为机制作为导致BPD患者攻击性改变的过程。高度集中的心理治疗将允许具有成本效益的干预，并可能支持精神病学目前的努力，以开发未来基于机制的治疗。