Cognitive Behavioral Aggression Treatment: Effects on Brain and Behavior

描述（由申请人提供）：攻击性行为是全球主要的公共卫生问题，每年在医疗保健和生产力损失方面花费数百亿至数千亿美元。人的代价同样巨大，给侵略者、受害者、亲人和整个社会造成痛苦和痛苦。尽管如此，目前还没有经验支持病理情感（敌意）攻击的治疗方法。大量文献表明，攻击性与社会情绪信息处理受损有关，而社会情绪信息处理是由大脑中的前额叶-边缘回路控制的。这一观点得到了一些研究的支持，这些研究表明，对消极的社会情绪刺激（如愤怒的面部表情或消极的唤起性图片），具有攻击性的受试者的杏仁核反应增加，眶内侧前额叶反应减少。认知行为治疗的一个目标是减少功能失调的社会情绪信息处理。PI的初步数据表明，12次的认知行为攻击治疗可能有效地减少攻击行为和与情感攻击相关的潜在认知（社会情绪信息处理）和生物（皮质边缘激活）缺陷。为了评估这种治疗的效果，120名具有临床相关情感攻击的受试者将被随机分为认知行为攻击治疗组和支持性心理治疗组。所有受试者将在整个积极治疗阶段使用生态瞬时评估（EMA）监测他们的攻击行为。同时完成攻击行为和社会情绪信息加工的自我报告和行为、治疗前和治疗后，并在随访6个月和1年时再进行一次。为了评估认知行为治疗对皮质边缘功能的影响，被试在治疗前和治疗后分别接受功能磁共振成像（fMRI）检查，同时完成两项社会信息处理任务（识别面孔的情绪效价和唤起性图片）。假设相对于支持性心理治疗，认知行为攻击治疗可以减少攻击行为，改善社会情绪信息加工，减少杏仁核/增加眶内侧前额叶对社会情绪刺激的激活。

DESCRIPTION (provided by applicant): Aggressive behavior is a leading worldwide public health problem costing tens to hundreds of billions of dollars annually in terms of medical care and lost productivity. The human cost is equally great, creating distress and suffering in the aggressor, their victim, loved ones and society as a whole. Despite this there are currently no empirically supported treatments for pathological affective (hostile) aggression. A rich literature suggests that aggression is associated with impaired socio-emotional information processing, which is governed by a prefrontal-limbic circuit in the brain. This is supported by studies of affectively aggressive subjects showing increased amygdala response and decreased orbitomedial prefrontal response to negative socio-emotional stimuli such as angry facial expressions or negative evocative pictures. A goal of cognitive behavioral therapy is to reduce dysfunctional socio- emotional information processing. Preliminary data by the PI suggests a 12- session cognitive behavioral aggression treatment may be efficacious in reducing aggressive behavior and underlying cognitive (socio-emotional information processing) and biological (cortico-limbic activation) deficits associated with affective aggression. To assess the efficacy of this treatment, 120 subjects with clinically relevant affective aggression would be randomized to either the cognitive-behavioral aggression treatment or a supportive psychotherapy control. All subjects will monitor their aggressive behavior throughout the active treatment phase using ecological momentary assessment (EMA). Subjects would also complete self-report and behavioral of both aggression and social-emotional information processing and pre-treatment and post-treatment, then again at 6-month and 1-year follow-up. To assess the effect of the cognitive behavioral treatment on cortico-limbic functioning, subjects would complete two social information processing tasks (identifying the emotional valence of faces and evocative pictures) while undergoing functional Magnetic Resonance Imaging (fMRI) at pre-treatment and again at post- treatment. It is hypothesized that relative to supportive psychotherapy, the cognitive behavioral aggression treatment will result in decreased aggressive behavior and improved socio- emotional information processing as well as decreased amygdala/increased orbitomedial prefrontal activation to socio-emotional stimuli.