Combining Electrophysiological, Behavioral and Psychological Measures to Target Mechanisms of Emotion Processing and Regulation During Cognitive Behavior Therapy in Depression

项目总结 此R21应用程序旨在阐明认知过程中发生变化的神经生物学机制 行为疗法(CBT)治疗严重抑郁障碍(MDD)。这项假设驱动的研究将探索 心理心智(PM)与正念(M)心理结构的关系 MDD患者CBT的时程变化及其与电生理和自动行为指标的关系 (即刺激驱动或自下而上)情绪加工。这一目标的动机是基于以下理由：PM 和M代表了被认为对情绪调节至关重要的自我知识的不同元认知过程 和CBT的成功。显著情感图片的事件相关电位(ERPs)反映了动机的不同阶段 请注意。使用先进的分析脑电技术，我们已经将这些阶段与脑电的分级激活联系起来 沿枕颞部腹侧流的“情绪”脑区，从意识前刺激到 分类(右侧次级视觉皮质，右侧顶叶交界处)到有意识的评估(后方 扣带皮质、腹内侧皮质)。重要的是，事件相关电位对情绪激发刺激的反应迟钝 在临床抑郁症中观察到，右侧顶叶和额背外侧活动不足 在抗抑郁药物或电惊厥治疗成功后，区域恢复正常。一种二分情感识别方法 测试，它以左耳(右半球)的形式提供自下而上的情绪处理的听觉测量 识别语音模式的情绪语调的优势揭示了MDD的行为缺陷 病人。此外，在CBT中，右耳对言语刺激(左半球)的优势增加 响应者。采用随机分配到CBT或非特异性支持治疗的60名MDD患者样本 (安慰剂)，我们将获得心理、电生理、行为和临床结果的反应测量 到12周的CBT在治疗前和治疗后的设计中确定：(1)何时何地在大脑中自动 情绪加工被CBT改变；(2)情绪反应的变化是否被元-反应调节或调节 自我认识的认知过程；以及，(3)如果这些措施单独或结合起来，有希望成为 CBT治疗反应的标志物。健康成人(HC)的现有事件相关电位和行为数据 相同的实验方案将提供标准化(标尺)数据。这项研究汇集了经验丰富的临床医生 心理学家和精神病学家在有专业知识的调查人员的帮助下治疗和研究抑郁症 在MDD的情感神经科学和电生理学研究中。它将为勾勒出 通过CBT发生变化的内质网的情感-认知和神经生理机制。除了 他们的理论相关性，这个项目的发现也将有助于开发新的和更有针对性的 并确定哪些患者可能从CBT治疗单相抑郁症中受益最多。

PROJECT SUMMARY This R21 application aims to clarify the neurobiological mechanisms by which change occurs during cognitive behavior therapy (CBT) for major depressive disorder (MDD). This hypothesis-driven study will explore the association between the psychological constructs of psychological mindedness (PM) and mindfulness (M) during the time course of CBT for MDD, and its relationship to electrophysiological and behavioral measures of automatic (i.e. stimulus-driven or bottom-up) emotion processing. This objective is motivated by the following rationale: PM and M represent different meta-cognitive processes of self-knowledge deemed critical for emotion regulation (ER) and CBT success. Event-related potentials (ERPs) to salient affective pictures reflect different stages of motivated attention. Using advanced analytic EEG techniques, we have linked these stages to the hierarchical activation of `emotional' brain regions along the occipitotemporal ventral stream, ranging from preconscious stimulus categorization (right secondary visual cortex, right temporoparietal junction) to conscious appraisal (posterior cingulate cortex, ventromedial cortex). Importantly, blunted ERP responses to emotionally-arousing stimuli have been observed in clinical depression, and hypoactivation of right temporoparietal and dorsolateral prefrontal regions normalize after successful antidepressant or electroconvulsive treatment. A dichotic emotion recognition test, which provides an auditory measure of bottom-up emotion processing in form of a left ear (right hemisphere) advantage for recognizing the emotional intonation of speech patterns, has revealed behavioral deficits in MDD patients. Moreover, an increased right ear advantage for verbal stimuli (left hemisphere) is seen in CBT responders. Employing a sample of 60 MDD patients randomly assigned to CBT or nonspecific supportive therapy (placebo), we will obtain psychological, electrophysiological, behavioral and clinical outcome measures of response to 12 weeks of CBT in a pre-post treatment design to determine: (1) when and where in the brain automatic emotion processing is altered by CBT; (2) if changes in emotional responding are moderated or mediated by meta- cognitive processes of self-knowledge; and, (3) if these measures, alone or in combination, have promise as markers of CBT treatment response. Existing ERP and behavioral data for healthy adults (HC) obtained using the same experimental protocols will provide normative (yardstick) data. This study brings together experienced clinical psychologists and psychiatrists doing treatment and research in depression with investigators having expertise in affective neuroscience and electrophysiological studies in MDD. It will provide a critical new step for outlining the affective-cognitive and neurophysiological mechanisms of ER by which change through CBT occurs. Apart from their theoretical relevance, the findings of this project will also aid in developing novel and more targeted interventions and in identifying patients who may benefit most from CBT for unipolar depression.