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The Neurobiology of Psychotherapy: Emotional Reactivity and Regulation in PTSD

心理治疗的神经生物学：创伤后应激障碍的情绪反应和调节

基本信息

批准号：
8724560
负责人：
Amit Etkin
金额：
$ 26.6万
依托单位：
PALO ALTO VETERANS INSTIT FOR RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8724560
关键词：
Aftercare Amygdaloid structure Animal Model Anterior Anxiety Anxiety Disorders Awareness Base of the Brain Biological Markers Brain Clinical Conflict (Psychology)Conscious Data Development Disease Dorsal Down-Regulation Emotional Emotions Evidence based treatment Face Fright Functional Magnetic Resonance Imaging Future Goals Inferior frontal gyrus Intervention Knowledge Lateral Left Life Location Maps Medial Mental disorders Mood Disorders National Institute of Mental Health Neurobiology Neurosciences Outcome Patients Pattern Plague Post-Traumatic Stress Disorders Prefrontal Cortex Process Psychiatry Psychopathology Psychotherapy Public Health Regulation Research Route Site Solutions Stimulus Strategic Planning System Therapeutic Transcranial magnetic stimulation Translating Translations Waiting Lists base design effective therapy emotion regulation evidence base follow-up neural circuit neurobiological mechanism neuroimaging neuromechanism novel programs relating to nervous system response tool treatment response

项目摘要

Psychotherapy remains a cornerstone of treatment for many psychiatric disorders, and can be highly highly effective for a portion of patients. Very little, however, is understood about the neurobiological mechanisms of action of psychotherapy, nor are there biological markers for who is likely to respond. For some disorders, such as posttraumatic stress disorder (PTSD), psychotherapy is also the only evidence-based treatment, leaving non-responders with no effective treatment alternative. A lot is known, by contrast, about the neural basis of PTSD. Despite this, there is a large gap between our understanding of the neural basis of psychopathology in PTSD and the mechanisms of therapeutic change, and an even larger gap between those and an ability to use information from neuroimaging studies to guide the development of novel, neurocircuitry-targeting treatments. This latter issue is one, in fact, that plagues neuroimaging studies of psychiatric disorders more generally. Development of such novel treatments is a major goal of the Strategic Plan of the NIMH, and thus the BRAINS RFA, and may bring new hope to the treatment of severe illnesses, such as PTSD. The overall goal of this research program is to apply functional magnetic resonance imaging (fMRI) to elucidate the brain circuitry underlying improvement in response to psychotherapy, and to leverage this knowledge to develop a novel, personalized, neurocircuitrytargeting treatment using transcranial magnetic stimulation (TMS). One potential mechanism of action of psychotherapy is the alteration of patterns of dysfunctional emotional processing. Numerous studies with healthy subjects has delineated the neural circuitry for reacting to and regulating negative emotion, and how it is perturbed in psychopathology. We propose to build on this knowledge and study psychotherapeutic change and its pretreatment predictors by systematically probing emotional reactivity and regulation using fMRI in patients with PTSD before and after treatment with prolonged exposure psychotherapy (PE), versus wait list. Before receiving PE, all patients will undergo mapping of the prefrontal cortex using concurrent TMS and fMRI. Patterns of brain activation induced and modulated by TMS at a variety of prefrontal sites will be compared to those associated with successful PE, thereby forming the basis for a future neuroimaging-guided TMS intervention strategy that is directly informed by an understanding of the neurocircuitry of treatment response. A successful outcome in this study may therefore produce a paradigm shift in the translation of clinical neuroscience to brain circuitbased interventions.

心理治疗仍然是许多精神疾病治疗的基石，对一部分患者非常有效。然而，人们对这一点知之甚少。心理治疗的神经生物学作用机制，也没有生物学标志物，谁可能会回应。对于一些疾病，如创伤后应激障碍（PTSD），心理治疗也是唯一的循证治疗，使无反应者没有有效的治疗方法。相比之下，关于PTSD的神经基础，我们已经知道了很多。尽管如此，在我们对神经基础的理解之间存在着很大的差距。 PTSD的精神病理学和治疗变化的机制，甚至更大的差距以及利用神经影像学研究的信息来指导开发新的神经回路靶向治疗。事实上，后一个问题是，更普遍地困扰着精神疾病的神经影像学研究。发展这种新的治疗方法是NIMH战略计划的主要目标，因此也是BRAINS RFA的主要目标，并可能为创伤后应激障碍等严重疾病的治疗带来新的希望。这项研究计划的总体目标是将功能性磁共振技术应用于功能性磁共振成像（fMRI），以阐明大脑回路的改善，心理治疗，并利用这些知识来开发一种新的，个性化的，神经回路靶向使用经颅磁刺激（TMS）治疗。一种潜在的机制心理治疗的作用是改变功能失调的情绪处理模式。对健康受试者的许多研究已经描绘了神经回路，调节负面情绪，以及它在精神病理学中是如何被扰乱的。我们提出建设在此基础上，研究心理治疗变化及其治疗前预测因素，使用功能磁共振成像系统地探索PTSD患者的情绪反应和调节治疗前和治疗后的长期暴露心理治疗（PE），与等待名单。之前接受PE，所有患者将使用并行TMS进行前额叶皮层标测和功能磁共振成像经颅磁刺激诱发和调节的不同前额叶皮层的脑激活模式将与成功PE相关的站点进行比较，从而为未来的神经成像引导的TMS干预策略，直接由了解治疗反应的神经回路。这项研究的成功结果因此，可能会在临床神经科学向基于脑回路的翻译中产生范式转变。干预措施。