The Neurobiology of Psychotherapy: Emotional Reactivity and Regulation in PTSD

心理治疗仍然是许多精神疾病治疗的基石， 对部分患者非常有效。然而，人们对此了解甚少。 心理治疗作用的神经生物学机制，也没有生物标记物 谁可能会做出回应。对于一些障碍，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 有效的治疗替代方案。相比之下，关于创伤后应激障碍的神经基础，人们知道的很多。 尽管如此，我们对神经基础的理解仍有很大差距。 创伤后应激障碍的精神病理学和治疗改变的机制，还有更大的差距 在这些和使用神经成像研究的信息来指导 开发新的神经回路靶向治疗方法。事实上，后一个问题是一个 瘟疫更普遍地影响了精神疾病的神经成像研究。这样的发展 新的治疗方法是NIMH战略计划的主要目标，因此大脑RFA， 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应用功能磁共振 磁共振成像(FMRI)以阐明脑回路潜在的反应改善 心理疗法，并利用这一知识开发一种新颖的、个性化的、以神经回路为靶向的 采用经颅磁刺激(TMS)治疗。一种潜在的机制是 心理治疗的作用是改变功能失调的情绪加工模式。 许多对健康受试者的研究已经描绘出了反应和 调节负面情绪，以及它在精神病理学中是如何受到干扰的。我们计划建造一座 关于心理治疗变化及其治疗前预测因素的认识与研究 应用功能磁共振成像系统探讨创伤后应激障碍患者的情绪反应和调节 治疗前后采用长时间暴露心理治疗(PE)，与等待名单对照。在此之前 接受PE后，所有患者都将使用同步TMS进行前额叶皮质标测 和功能磁共振成像。TMS在不同前额叶诱导和调节的脑激活模式 网站将与那些与成功的PE相关联的网站进行比较，从而形成 未来神经影像引导的TMS干预策略直接由 了解治疗反应的神经回路。这项研究的一个成功结果 可能因此导致临床神经科学向基于大脑回路的转换的范式转变 干预措施。

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.