Neurostimulation Enhanced Cognitive Restructuring for Transdiagnostic Emotional Dysregulation: A Component Analysis

神经刺激增强跨诊断情绪失调的认知重构：成分分析

• 批准号: 10583921
• 负责人: Andrada Delia Neacsiu
• 金额: $ 79.4万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-10-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583921
• 关键词: Address; Adult; Affective; Alcohol consumption; Amygdaloid structure; Anorexia; Anxiety Disorders; Area; Arousal; Autobiography; Behavior Therapy; Behavioral; Biological Markers; Bipolar I; Brain; Brain imaging; Clinical; Cognitive; Cognitive Therapy; Combined Modality Therapy; Communities; Control Groups; DSM-V; Depressed mood; Development; Diagnostic; Disease; Distress; Down-Regulation; Emotional; Emotions; Equilibrium; Exclusion; Exhibits; Frequencies; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Grant; Instruction; Insula of Reil; Integrative Therapy; Intervention; Interview; Knowledge; Learning; Left; Literature; Maintenance; Major Depressive Disorder; Measurement; Measures; Medial; Mediating; Memory; Modeling; Monitor; Mood Disorders; Neurobiology; Neuronavigation; Neurophysiology - biologic function; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Physiological; Prefrontal Cortex; Process; Psychiatric therapeutic procedure; Psychopathology; Psychophysiology; Psychotherapy; Psychotic Disorders; Public Health; Randomized; Recovery; Regulation; Reporting; Research; Sampling; Scanning; Stress; Structure; Testing; Time; Training; Translating; Visit; Work; affective neuroscience; anxious; biobehavior; burden of illness; clinical diagnostics; clinical practice; clinically significant; cognitive enhancement; cognitive neuroscience; electric field; emotion dysregulation; emotion regulation; emotional functioning; expectation; flexibility; follow-up; functional gain; heart rate variability; imaging study; improved; indexing; individual variation; insight; neural; neural network; neurobehavioral; neurophysiology; neuroregulation; noninvasive brain stimulation; novel; novel strategies; novel therapeutic intervention; placebo controlled trial; psychoeducation; psychoeducational; remediation; repetitive transcranial magnetic stimulation; response biomarker; sex; skills; stress disorder; stressor; substance use; success; therapy duration; tool

Emotional dysregulation constitutes a serious public health problem and novel approaches are needed to effectively address it transdiagnostically. Despite rapid advancements in affective and cognitive neuroscience, there have been few attempts to translate basic findings into novel interventions. In addition, the relevance of different nodes in the emotion regulation network to psychopathology and to successful reduction of emotional arousal is not yet fully understood. Noninvasive neurostimulation, such as repetitive transcranial magnetic stimulation (rTMS), is a powerful tool with which dysfunction can be alleviated temporarily, by modulating neural activation. Therefore, the objective of the current study is to examine immediate neural and behavioral changes following neuromodulation enhanced emotion regulation training for transdiagnostic adults who report difficulties calming down when upset. The central hypothesis is that neurostimulation enhances the acquisition of emotion regulation skills and leads to remediated neural function in the emotion regulation network. Our long-term goal is to develop novel interventions that harness neuroscientific findings to advance behavioral treatments. The primary aim of this project is to evaluate the unique neural and behavioral effects of a one-session training combining cognitive restructuring (CR), an emotion regulation skill, with excitatory rTMS over the dorsolateral prefrontal cortex (dlPFC). The secondary aim is to identify key changes in the emotion regulation neural network following the combined intervention versus each of the components alone. The third aim is to explore personalized biomarkers for response to emotion regulation training. To achieve these aims, 240 rTMS naïve, community adults who meet criteria for affective or stress DSM-5 disorders (excluding if co-occurring anorexia, alcohol and substance use, bipolar I, or psychotic disorders) and who self-report high emotional dysregulation and low use of CR will participate in brain imaging while undergoing an emotional regulation task. Participants will be randomly assigned to CR training (groups 1 & 2) or to psychoeducation about emotions (group 3; aimed to control for nonspecific factors). Participants will be reminded of recent stressors and will undergo real (groups 1 & 3) or sham (group 2) high frequency rTMS, targeted using fMRI results. Participants who learned CR will practice this skill during rTMS in a one-time session, and physiological arousal will be monitored throughout the emotion induction and regulation practice. Following this training, participants will undergo another functional scan and an exit interview to assess for immediate neural and behavioral changes. Bio- behavioral measures of emotion regulation will be assessed at a one week and a one month follow up visit. If successful, our line of research will provide key mechanistic information to develop a novel transdiagnostic treatment for affective and stress disorders.

情绪失调构成了一个严重的公共卫生问题，需要新的方法来 有效地解决它transdiagnotic。尽管情感和认知神经科学发展迅速， 很少有人试图将基本研究结果转化为新的干预措施。此外， 情绪调节网络中的不同节点与精神病理学和成功减少情绪 唤醒还没有被完全理解。无创神经刺激，如重复经颅磁刺激 经颅磁刺激（rTMS）是一种强有力的工具，通过调节功能障碍，可以暂时缓解功能障碍。 神经激活因此，本研究的目的是检查即时的神经和行为 神经调节增强情绪调节训练后的变化， 心烦意乱时难以平静下来。核心假设是神经刺激增强了 获得情绪调节技能并导致情绪调节中的补救神经功能 网络我们的长期目标是开发新的干预措施，利用神经科学的发现， 行为治疗 这个项目的主要目的是评估一次训练对神经和行为的独特影响 结合认知重建（CR），情绪调节技能，与背外侧兴奋性rTMS 前额叶皮层（dlPFC）。第二个目的是确定情绪调节神经元中的关键变化， 网络后的组合干预与每个组件单独。第三个目标是探索 个性化的生物标志物，用于对情绪调节训练的反应。为了实现这些目标，240 rTMS初治， 符合情感或压力DSM-5障碍标准的社区成年人（排除同时发生的厌食症， 酒精和物质使用，双相I型，或精神病性障碍）和自我报告高度情绪失调 而低使用CR将参与大脑成像，同时进行情绪调节任务。参与者 将被随机分配到CR培训（第1和2组）或有关情绪的心理教育（第3组;旨在 以控制非特异性因素）。参与者将被提醒最近的压力源，并将经历真实的 （组1和3）或假手术（组2）高频rTMS，使用fMRI结果靶向。参加者学习 CR将在rTMS期间一次性练习这项技能，并监测生理唤醒 在整个情绪诱导和调节练习中。培训结束后，学员将接受 再做一次功能扫描和离职面谈以评估是否有即时的神经和行为变化。生物- 情绪调节的行为测量将在一周和一个月的随访中进行评估。如果 如果成功，我们的研究将为开发一种新的转诊断方法提供关键的机制信息。 治疗情感和压力障碍。