An fMRI Study of the Enhancement of Emotion Regulation in Borderline Patients

描述（由申请人提供）：边缘型人格障碍（BPD）是一种常见的精神疾病，约2%至6%的人口和20%的住院精神病患者中发现。它的特点是激烈和快速的情绪变化，自我毁灭的行为，successuality，和动荡的关系。事实证明，无论是药物治疗还是心理治疗都很难治疗。据报道，自杀率约为10%。除了边缘患者及其亲人所经历的痛苦的情感成本之外，BPD患者通常在远低于具有可比智力的个体的水平上发挥作用，并且他们消耗了不成比例的心理健康资源。控制情绪的困难，所以中央的障碍，已被证明是一个特别困难的treat.The本研究利用最新的神经影像学研究结果在BPD产生新的想法的心理治疗的障碍。这个项目建立在我们以前的神经成像工作的基础上，它已经表明，当BPD患者试图通过采用健康人经常使用的方法来控制他们的情绪时，BPD患者无法让他们大脑中发出情绪警报信号的部分安静下来。本研究的目的是确定在使用这种健康的距离策略方面给予BPD患者特殊训练是否可以帮助他们提高调节情绪的能力，并使他们的大脑活动恢复到更正常的模式。我们将使用功能性磁共振成像技术记录BPD受试者在接受任何训练之前试图使用距离来减少他们对令人不安的图片的情绪反应时的大脑活动，然后让他们接受关于距离策略的特定训练。在这次训练之后，我们将再次获得功能性磁共振成像扫描，以确定他们的大脑激活模式是否正常化，以及他们是否能够更好地减少他们对图片的负面反应。如果这是有效的，它将表明，这种训练可以帮助BPD患者更好地调节他们的情绪，并将支持一个计划，以进一步发展和纳入BPD患者的心理治疗的距离训练。本研究的第二个目的是确定BPD患者在重新体验时对负面情况变得越来越敏感的趋势（如大脑情绪警报系统的活动增加所示）是否会随着额外的暴露而减少，就像恐惧症患者一样，或者会继续增加。了解这一点可以帮助治疗师计划如何在BPD患者的心理治疗中最有效地处理令人不安的生活经历。该项目代表了脑成像研究的重要一步，因为它应用了有关大脑活动模式的信息来开发心理治疗的新方法。它解决了一个严重的，普遍的和难以治疗的疾病。 公共卫生相关性：边缘型人格障碍（BPD）是一种常见的精神疾病，约占人口的2%至6%，占住院精神病患者的20%，已被证明具有相当的治疗抗性。除了10%的自杀率，边缘患者及其亲人所经历的痛苦的情感成本，BPD患者通常消耗不成比例的心理健康资源。这项研究是创新性的应用新的见解，从功能磁共振成像的大脑神经成像，开发新的方法来治疗边缘型人格障碍。

DESCRIPTION (provided by applicant): Borderline Personality Disorder (BPD) is a common psychiatric disorder found in approximately 2% to 6% of the population and 20% of hospitalized psychiatric patients. It is characterized by intense and rapid mood changes, self-destructive behavior, sucidality, and tumultuous relationships. It has proved very difficult to treat with either medications or psychotherapy. Suicide rates of approximately 10% have been reported. In additional to the emotional costs of the suffering experienced by borderline patients and their loved ones, BPD patients typically function at a level substantially below that of individuals with comparable intellect and they consume a disproportionate share of mental health resources. The difficulty controlling emotion, so central to the disorder, has proved a particularly difficult to treat. The present study utilizes the latest neuroimaging findings in BPD to generate new ideas for the psychotherapy of the disorder. This project builds upon our previous neuroimaging work, which has shown that when BPD patients try to control their emotions by employing a method that healthy people frequently use quite effectively-taking an emotional distance from what is upsetting-BPD patients are not able to quiet down the part of their brain that sends out emotional alarm signals. The objective of the present study is to determine whether giving BPD patients special training in using this healthy distancing stragegy can help them to improve their ability to regulate their emotions and return their brain activity to a more normal pattern. We will do this by using fMRI to record brain activity as BPD subjects try to use distancing to reduce their emotional reactions to upsetting pictures before any training, then to have them receive specific training in the distancing strategy. After this training we will again obtain an fMRI scan to determine whether their pattern of brain activation has normalized and whether they have been able to better reduce their negative reactions to the pictures. If this is effective, it will show that such training may help BPD patients better regulate their emotions and would support a program to further develop and incorporate distancing training into the psychotherapy of BPD patients. A second objective of the present study is to determine whether the tendancy of BPD patients to become increasingly sensitized to negative situations when they are re-experienced (as shown by increased activity of the brain's emotional alarm system), will reduce with additional exposure, as it does in patients with phobias, or will continue to increase. Knowing this can help the therapist plan how to most therapeutically approach disturbing life experiences in the psychotherapy of BPD patients. This project represents an important step in brain imaging research since it applies information learned about brain activity patterns to develop new approaches to psychotherapy. It addresses a serious, prevalent and difficult to treat disorder. PUBLIC HEALTH RELEVANCE: Borderline Personality Disorder (BPD), a prevalent psychiatric disorder found in approximately 2% to 6% of the population and 20% of hospitalized psychiatric patients, has proven quite treatment resistant. In additional to the 10% suicide rate, the emotional costs of the suffering experienced by borderline patients and their loved ones, BPD patients typically consume a disproportionate share of mental health resources. This study is innovative in applying new insights gained from fMRI neuroimaging of the brain to develop new approaches for the treatment of borderline personality disorder.