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

项目总结/摘要 边缘型人格障碍（BPD）是一种流行的，持久的和致残的精神疾病， 约2%至5.9%的人口[1，2]和20%的住院精神病患者。自杀 据报道，约有10%的发病率[3]。BPD最突出的临床特征之一是 极端的情绪变化[4-6]发生在对外部社会/情绪事件的反应[7-9]。的情感 BPD的不稳定性导致许多最致残，甚至危及生命的疾病症状， 包括自杀倾向、强烈愤怒的爆发和严重受损的角色功能[10]。的严重程度 BPD症状特征、其患病率、慢性化和对卫生保健服务的高负担[11-13]使得 发展有效和可获得的BPD治疗是一个高度优先事项。然而，目前没有任何药物 BPD的治疗和精神疗法已被证明具有 效应量小，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， 通过采用典型的适应性认知策略（认知重新评价，CR）来调节情绪， 有效地激活相关神经系统可以通过CR中的集中训练来纠正。R61阶段 本研究探讨了一个人工强化训练计划在CR，测试它的影响目标神经系统 参与情绪处理，并增强行为重新评估的成功。它检查2-，4-和6- 每周两次治疗，以确定最佳剂量。措施包括功能磁共振成像和临床 在基线和随后的每个时间点的评分。在证明CR培训具有上级优势后 对于在这些剂量持续时间中的一个或多个时增强神经靶中的表现的对照条件，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，以1）证明R61结果的重现性，2）证明CR培训优于上级 治疗结束时以及1个月和4个月随访时改善BPD临床结局的控制，以及3） 神经靶点活性的变化与临床改善相关。 这项研究的结果可以支持引入CR培训作为一种新的心理社会方法， BPD的治疗，作为独立治疗或作为增强策略。此外，它可能有 适用于一系列以严重情绪不稳定为特征的精神疾病。

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.