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

项目摘要/摘要 交界性人格障碍(BPD)是一种普遍的、持久的和致残的精神疾病 在大约2%到5.9%的人口[1，2]和20%的住院精神病患者中。自杀 据报道，这一比率约为10%[3]。BPD最显著的临床特征之一是 极端情绪变化[4-6]是对外部社会/情绪事件的反应[7-9]。情绪化 BPD的不稳定导致了这种疾病的许多最致残、甚至危及生命的症状， 包括自杀、强烈愤怒的爆发，以及角色功能严重受损[10]。这场战争的严重性 BPD的症状特征、其患病率、长期性和对医疗服务的高负担[11-13]使 开发有效和可获得的bpd治疗方法是一个高度优先事项。然而，目前还没有一种药物 治疗bpd的方法和公认的治疗该疾病的心理疗法已被证明具有 效果尺寸小，可获得性有限。 本研究建立在我们小组工作的基础上，该工作表明，在能力上的缺陷 通过采用典型的适应性认知策略(认知重新评估，CR)来调节情绪，并 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 这项研究考察了CR中的手工强化训练计划，测试了它对目标神经系统的影响 与情绪处理有关，并提高行为重新评估的成功率。它检查2-，4-和6- 每周治疗两次，以确定最佳剂量。措施包括功能磁共振成像和临床 在基线和每个后续时间点的评级。在证明CR培训优于 对于在这些剂量持续时间中的一个或多个提高神经靶点的性能的控制条件，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1)证明R61结果的重复性，2)证明CR培训优于 在治疗结束、1个月和4个月随访时改善BPD临床结果的对照，以及3) 神经靶点活动的这种变化与临床改善有关。 这项研究的结果可以支持引入认知行为训练作为一种新的心理社会方法 BPD的治疗，既可以作为单独治疗，也可以作为一种强化策略。此外，它可能已经 适用于以严重情绪不稳定为特征的一系列精神障碍。

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.