Neural Mechanisms Underlying MBSR and CBT in Patients/J.Gross

情绪失调被认为是许多医学和精神病学研究的核心机制。 紊乱特别是，情绪失调被认为在身体和情绪方面起着至关重要的作用。 对疼痛的反应。越来越多的基础研究开始阐明神经相关性， 情绪失调和疼痛感知的行为后遗症。同时，越来越多的 临床研究支持选定的心理社会干预措施对疼痛的疗效。然而， 了解这些治疗方法如何调节对疼痛的情绪反应。该研究将直接 通过研究两种不同的心理社会治疗模式-认知- 行为疗法（CBT）和基于正念的减压（MBSR）-影响两种特定形式的 CLBP患者的情绪调节-认知调节（CR）和注意力调节（AR）。背痛 影响高达85%的人在他们的生活;高达5%的所有成年人经历严重和衰弱的影响 的CLBP。CLBP与巨大的疾病负担相关：它具有高复发率，并且高度 合并精神疾病，包括重度抑郁症（MOD）、药物滥用和焦虑 紊乱虽然CLBP是功能性残疾和痛苦的主要原因， 治疗减少了痛苦，这一点还没有得到很好的理解。我们的总体方法是使用行为和神经 在随机对照试验的背景下测量情绪调节，以检查CBT与 MBSR对CLBP患者疼痛症状和幸福感的影响（目的1），CR和AR的差异变化 与CBT和MBSR（目的2）相关，并确定CR和AR是否介导治疗结果 (Aim 3）。广泛的，长期的目标，这一转化研究计划是提供一个实证基础 用于精炼和/或整合CLBP的CBT和MBSR的特定成分，并加强我们的 了解特定的情绪调节过程在CLBP中的作用，以及其他医学和 精神疾病

Emotion dysregulation is thought to be a core mechanism underlying many medical and psychiatric disorders. In particular, emotion dysregulation is believed to play a crucial role in physical and emotional responses to pain. A growing body of basic research is beginning to illuminate the neural correlates and behavioral sequelae of emotion dysregulation and perception of pain. Concurrently, a growing body of clinical research supports the efficacy of selected psychosocial interventions for pain. However, little is known about how these treatments modulate emotional reactivity to pain. The proposed study will directly address this knowledge gap by examining how two, distinct psychosocial treatment modalities-Cognitive- Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR)-impact two specific forms of emotion regulation-cognitive regulation (CR) and attention regulation (AR)-in patients with CLBP. Back pain affects up to 85% of people over their lives; up to 5% of all adults experience severe and debilitating effects of CLBP. CLBP is associated with a huge disease burden: it has a high rate of recurrence and is highly comorbid with psychiatric disorders, including major depression (MOD), substance abuse, and anxiety disorders. Although CLBP is a major cause of functional disability and suffering, how psychosocial treatments reduce that suffering is not well understood. Our overall approach is to use behavioral and neural measures of emotion regulation in the context of an RCT to examine the differential impacts of CBT versus MBSR on pain symptoms and well-being in patients with CLBP (Aim 1), to differential changes in CR and AR related to CBT versus MBSR (Aim 2), and to determine whether CR and AR mediate treatment outcome (Aim 3). The broad, long-term objective of this translational research program is to provide an empirical basis for refining and/or integrating specific components of CBT and MBSR for CLBP and strengthen our understanding of the role specific emotion regulation processes play in CLBP, as well as other medical and psychiatric disorders.