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精神障碍的核心机制。特别是，情绪调节失调被认为在焦虑和情绪障碍中起着至关重要的作用。越来越多的经验性工作开始阐明焦虑和情绪障碍患者情绪失调的神经关联和行为后遗症。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考察两种心理社会治疗方式--认知-行为疗法(CBT)和基于正念的压力减轻(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)，直接解决我们知识中的这一差距。我们建议的研究的临床背景是广泛性社交焦虑障碍(SAD)，这是一种非常普遍的、持续的、经常使人虚弱的精神疾病，其特征是压倒性的恐惧和对社交场合的回避。我们提出的研究涉及三个主要目标：目的1考察认知功能障碍和认知功能障碍在SAD和HC中的疗效和神经基础。目的2研究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在CBT和MBSR的影响之间起中介作用。成年SAD患者将被随机分配到CBT、MBSR或WL，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，以及社会评估任务期间情绪反应和情绪调节的功能神经成像)。这一翻译研究计划的广泛、长期目标是加深我们对基本情绪调节机制的理解，并促进临床干预措施的进步，以改善社交焦虑症(SAD)以及一系列其他焦虑和情绪障碍患者的健康。

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.