Emotion regulation in patients with obsessive-compulsive disorder

情绪体验是基于对显著刺激的即时评价（由大脑边缘区域提供）和前额叶控制机制（充分调节初始情绪反应）之间的相互作用。在以情绪亢奋为特征的精神疾病中，人们认为这两个过程不平衡（Phillips et al., 2003b）。情绪（日）调节模型有助于更好地理解强迫症（OCD）患者所经历的病理性焦虑。初步证据表明，强迫症的特征是情绪调节困难，这是自我报告测量的结果（de la Cruz et al., 2013）。此外，强迫症似乎与涉及情绪处理和情绪调节的大脑区域的功能变化有关（Milad & Rauch, 2012）。因此，神经影像学结果表明，在强迫症症状激发期间，大脑边缘和额叶区域的活动增加（例如，Simon等人，2010年），这表明当强迫症相关刺激被处理时，皮质-边缘相互作用发生了改变。然而，情绪调节策略尚未在强迫症中得到直接检验。因此，我们在第一项研究中调查了强迫症患者是否可以通过视觉分心来减少由焦虑刺激引起的觉醒。与自我参照任务相比，在视觉分散任务中，患者的杏仁核对强迫症相关刺激的反应减弱（Simon等人，提交）。由于强迫症相关焦虑受到功能失调信念和认知错误（如灾难化）的强烈影响，我们假设强迫症患者在使用认知情绪调节策略时，情绪调节受到损害。因此，本项目旨在通过事件相关电位（event-相关potential）研究强迫症的认知情绪调节（认知分心和认知重评）（研究一），并研究情绪调节在外部引导下是否可以补偿情绪调节缺陷（研究二）。

Emotional experience is based upon the interplay between the instantaneous appraisal of salient stimuli, provided by limbic brain areas, on the one hand, and prefrontal control mechanisms to adequately regulate the initial emotional response, on the other hand. In psychiatric disorders that are characterized by emotional hyperarousal, an imbalance of these two processes has been assumed (Phillips et al., 2003b). Models of emotional (dys)regulation may contribute to a better understanding of pathological anxiety experienced by patients with obsessive compulsive disorder (OCD). Initial evidence suggests that OCD is characterized by emotion regulation difficulties as indicated by self-report measures (de la Cruz et al., 2013). Further, OCD appears to be linked to functional changes in brain areas implicated in emotion processing and emotion regulation (Milad & Rauch, 2012). Thus, neuroimaging findings have demonstrated increased activity in both limbic and frontal brain areas during symptom provocation in OCD (e.g., Simon et al., 2010), suggesting altered cortico-limbic interactions, when OCD-relevant stimuli are being processed. However, emotion regulation strategies have not yet been directly examined in OCD. Therefore, we investigated in a first study, whether arousal elicited by anxiety-provoking stimuli can be reduced by visual distraction in OCD. Compared to a self-referential task, an attenuated amygdala response to OCD-relevant stimuli was found for patients during a visual distraction task (Simon et al., submitted). Because OCD-related anxiety is strongly influenced by dysfunctional beliefs and cognitive errors (e.g., catastrophizing), we suppose that emotion regulation is impaired in OCD patients specifically when using cognitive emotion regulation strategies. Therefore, this project aims at investigating cognitive emotion regulation (cognitive distraction and cognitive reappraisal) in OCD by using event-related potentials (study I) and examining whether emotion regulation deficits can be compensated when emotion regulation is guided externally (study II).