Cognitive Behavioral Aggression Treatment: Effects on Brain and Behavior

描述（由申请人提供）：攻击性行为是一个主要的全球公共卫生问题，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苦难。尽管如此，目前还没有经验支持的治疗病理性情感（敌意）侵略。大量的文献表明，攻击性与受损的社会情绪信息处理有关，这是由大脑中的前额叶边缘回路控制的。这一点得到了情感攻击性受试者研究的支持，这些受试者对负面社会情绪刺激（如愤怒的面部表情或负面唤起图片）的杏仁核反应增加，眶内侧前额叶反应减少。认知行为疗法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次认知行为攻击治疗可能有效减少攻击行为以及与情感攻击相关的潜在认知（社会情感信息处理）和生物（皮质边缘激活）缺陷。为了评估这种治疗的有效性，120名具有临床相关情感攻击的受试者将被随机分配到认知行为攻击治疗组或支持性心理治疗对照组。所有受试者将使用生态瞬时评估（EMA）在整个活性治疗阶段监测其攻击行为。受试者还将完成自我报告和行为的攻击和社会情绪信息处理和治疗前和治疗后，然后再次在6个月和1年的随访。为了评估认知行为治疗对皮质边缘功能的影响，受试者将在治疗前和治疗后接受功能性磁共振成像（fMRI）的同时完成两项社会信息处理任务（识别面部和唤起图片的情感效价）。据推测，相对于支持性心理治疗，认知行为攻击治疗将导致攻击行为减少和社会情绪信息处理改善以及杏仁核减少/眶内侧前额叶对社会情绪刺激的激活增加。

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.