Effects of emotion-focused vs cognitive interventions of schema therapy on emotion regulation deficits in females suffering borderline personality disorder – interrelations between clinical efficacy, connectivity in the executive control and salience netw

图式治疗的以情绪为中心的干预与认知干预对边缘性人格障碍女性情绪调节缺陷的影响 临床疗效、执行控制连接性和显着性网络之间的相互关系

• 批准号: 424869737
• 负责人: Professor Dr. Jürgen R. Reichenbach
• 金额: --
• 依托单位: AG Medizinische Physik
• 依托单位国家: 德国
• 项目类别: Research Grants
• 资助国家: 德国
• 项目状态: 未结题
• 来源: https://gepris.dfg.de/gepris/projekt/424869737?language=en
• 关键词: Effects; emotion; focused; vs; cognitive

The major aim of this proposal is to compare the effects of emotion focused (experiential) and cognitive interventions of schema therapy (ST) on emotion regulation deficits in females with borderline personality disorder (BPD) according to DSM-V (alternative model) criteria. In a randomized, single-blinded design clinical effects as well as effects on connectivity and neurotransmitter metabolism will be compared. While the 9-weeks treatment protocol of particular interest includes emotion focused interventions (ST-EF, n=60) such as chair dialogs, imagery rescripting or role play, the control condition (ST-AC, n=60) is restricted to cognitive interventions, e.g. psychoeducation or pro/contra discussions. Resting-state functional MR imaging (rs-fMRI) and MEGA-PRESS 1H-MR spectroscopy will be applied before/after 3 weeks of familiarization/diagnostics (T0-T1) and before/after the treatment protocols (T1-T2) to investigate effects on the connectivity in executive control (ECN) and salience (SN) networks and the glutamate (Glx) und GABA metabolism in key regions (ECN dorsolat. prefrontal cortex, DLPFC; SN anteromed. cingulate cortex, aMCC). The biological aberrations at T0 as compared to healthy controls (n=60) and treatment effects (T1-T2, n≥40 in each condition) on these aberrations will be linked to clinical effects measured by an extensive test battery with particular interest on emotion regulation, and specified by the Reliable Change Index (RCI). For longitudinal data mixed model analysis will be performed. Skin conductance as a correlate of vegetative activation will be used to quantify the intensity of emotional activation during therapeutic sessions. Main questions are (i) whether the emotion regulation deficit in patients co-occurs with a specific pattern of Glx and GABA concentrations at aMCC and DLPFC and respective aberrations of functional connectivity within the ECN and SN. Depending on the deficit (measured by ERI, FSVV), we hypothezise a pattern of glutamatergic hyper- and/or GABA-ergic hypofunction in the aMCC, glutamatergic hypo- and/or GABA-ergic hyperfunction in the DLPFC and abnormal RSFC in the ECN and SN at T0. (ii) whether both treatment conditions cause different clinical effects on emotion regulation capabilities and other core symptoms of BPD (expressed by individual RCIs). We hypothesize that clinical effects of the treatment conditions differ in size/pattern, in terms of emotion regulation in favor of the ST-EF condition. (iii) whether these patterns of clinical improvement are linked to the changes of neurobiological aberrations (core issue of the proposal). We hypothesize that in particular ST-EF induced clinical effects on emotion regulation and other core BPD symptoms are interrelated with specific patterns of ST-EF induced changes of neurobiological parameters. (iv) We also hypothesize that the pattern of clinical improvement as defined by RCI can be predicted by the pattern of neurobiological aberrations at T1.

该提案的主要目的是根据DSM-V（替代模型）标准，比较图式疗法（ST）的情绪聚焦（体验式）和认知干预对边缘性人格障碍（BPD）女性情绪调节缺陷的影响。在随机、单盲设计中，将比较临床效果以及对连通性和神经递质代谢的影响。虽然特别感兴趣的 9 周治疗方案包括以情绪为中心的干预措施（ST-EF，n=60），例如椅子对话、图像重写或角色扮演，但控制条件（ST-AC，n=60）仅限于认知干预，例如认知干预。心理教育或赞成/反对讨论。将在 3 周的熟悉/诊断 (T0-T1) 之前/之后以及治疗方案 (T1-T2) 之前/之后应用静息态功能 MR 成像 (rs-fMRI) 和 MEGA-PRESS 1H-MR 波谱，以研究对执行控制 (ECN) 和显着性 (SN) 网络的连接性以及关键区域 (ECN dorsolat. 前额皮质，DLPFC； SN 前体。扣带皮层，aMCC）。与健康对照 (n=60) 相比，T0 时的生物畸变以及对这些畸变的治疗效果 (T1-T2，每种情况下 n≥40) 将与通过广泛的测试组测量的临床效果相关，特别关注情绪调节，并由可靠变化指数 (RCI) 指定。对于纵向数据，将进行混合模型分析。皮肤电导作为植物激活的相关性将用于量化治疗过程中情绪激活的强度。主要问题是 (i) 患者的情绪调节缺陷是否与 aMCC 和 DLPFC 处 Glx 和 GABA 浓度的特定模式以及 ECN 和 SN 内各自的功能连接异常同时发生。根据缺陷（通过 ERI、FSVV 测量），我们假设 aMCC 中谷氨酸能高和/或 GABA 能功能减退、DLPFC 中谷氨酸能低和/或 GABA 能功能亢进以及 ECN 和 SN 中 RSFC 在 T0 时异常。 (ii) 两种治疗条件是否会对 BPD 的情绪调节能力和其他核心症状（以个体 RCI 表示）产生不同的临床影响。我们假设治疗条件的临床效果在大小/模式上有所不同，在有利于 ST-EF 条件的情绪调节方面。 (iii) 这些临床改善模式是否与神经生物学畸变的变化有关（该提案的核心问题）。我们假设，特别是 ST-EF 诱导的对情绪调节和其他核心 BPD 症状的临床影响与 ST-EF 诱导的神经生物学参数变化的特定模式相关。 (iv) 我们还假设 RCI 定义的临床改善模式可以通过 T1 时的神经生物学畸变模式来预测。