fMRI of Emotion Regulation During RCT of CBT vs. MBSR for Social Anxiety Disorder

描述（由申请人提供）：情绪失调被认为是许多Axis-I和Axis-II精神疾病的核心机制。特别是情绪调节障碍被认为在焦虑和心境障碍中起着至关重要的作用。越来越多的实证研究开始阐明焦虑和情绪障碍患者情绪失调的神经相关性和行为后遗症。然而，关于焦虑和情绪障碍的心理社会治疗如何影响情绪失调，人们知之甚少。这项拟议的研究将通过研究两种心理社会治疗模式-认知行为疗法（CBT）和基于正念的减压（MBSR）-如何影响两种特定形式的情绪调节-认知调节（CR）和注意力调节（AR）来直接解决我们知识中的这一差距。我们所提出的研究的临床背景是广泛性社交焦虑症（SAD），这是一种高度流行、持续且经常使人衰弱的精神疾病，其特征是过度恐惧和回避社交场合。我们提出的研究解决了三个主要目标：目标1检查CR和AR在SAD与HC中的疗效和神经基础。目的2调查CBT与MBSR对SAD的直接和长期影响。目的3检查CR和AR的变化，并测试这些变化是否介导CBT与MBSR的效应。SAD成人患者将被随机分配到CBT、MBSR或WL组，并在基线、治疗后立即和治疗完成后6个月进行评估（包括临床诊断访谈、精神病学和个体差异问卷以及社会评价任务期间情绪反应和情绪调节的功能性神经成像）。该转化研究计划的广泛、长期目标是进一步了解基本的情绪调节机制，并为临床干预措施的进步做出贡献，这些干预措施将改善患有社交焦虑症（SAD）以及一系列其他焦虑症和情绪障碍的人的健康状况。

DESCRIPTION (provided by applicant): Emotion dysregulation is thought to be a core mechanism underlying many Axis-I and Axis-II psychiatric disorders. In particular, emotion dysregulation is believed to play a crucial role in the anxiety and mood disorders. A growing body of empirical work is beginning to illuminate the neural correlates and behavioral sequelae of emotion dysregulation in individuals suffering from anxiety and mood disorders. However, little is known about how psychosocial treatments for anxiety and mood disorders impact emotion dysregulation. The proposed study will directly address this gap in our knowledge by examining how two 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). The clinical context for our proposed study is generalized Social Anxiety Disorder (SAD), a highly prevalent, persistent, and often debilitating psychiatric condition characterized by overwhelming fear and avoidance of social situations. Our proposed research addresses three major aims: Aim 1 examines the efficacy and neural bases of CR and AR in SAD versus HC. Aim 2 investigates the immediate and longer-term impact of CBT versus MBSR for SAD. Aim 3 examines changes in CR and AR and tests whether these changes mediate effects of CBT versus MBSR. Adult patients with SAD will be randomly assigned to CBT, MBSR, or WL and administered assessments (including clinical diagnostic interviews, psychiatric and individual difference questionnaires, and functional neuroimaging of emotional reactivity and emotion regulation during a social evaluation task) at baseline, immediately after treatment, and 6 months post-treatment completion. The broad, long-term objective of this translational research program is to further our understanding of basic emotion regulation mechanisms and to contribute to advances in clinical interventions that will improve the health of individuals suffering from Social Anxiety Disorder (SAD) as well as a range of other anxiety and mood disorders.