An fMRI Study of the Enhancement of Emotion Regulation in Borderline Patients

描述（由申请人提供）：边缘型人格障碍（BPD）是一种常见的精神障碍，约占人口的2%至6%，占住院精神病患者的20%。其特征是强烈而迅速的情绪变化、自我毁灭行为、自杀倾向和混乱的人际关系。事实证明，无论是药物治疗还是心理治疗，都非常困难。据报道，自杀率约为10%。除了边缘性人格障碍患者及其亲人所经历的痛苦所带来的情感成本之外，BPD患者的典型功能水平远低于具有同等智力的个体，而且他们消耗的心理健康资源份额不成比例。控制情绪的困难是这种障碍的核心，事实证明这种困难特别难以治疗。本研究利用最新的BPD神经影像学发现，为该疾病的心理治疗提供新的思路。这个项目建立在我们之前的神经成像工作的基础上，该工作表明，当BPD患者试图通过一种健康人经常使用的非常有效的方法来控制自己的情绪时——与令人不安的事情保持情感距离——BPD患者无法使他们大脑中发出情绪警报信号的部分平静下来。本研究的目的是确定是否给予BPD患者使用这种健康的距离策略的特殊训练可以帮助他们提高调节情绪的能力，并使他们的大脑活动恢复到更正常的模式。我们将通过fMRI来记录BPD受试者在任何训练前尝试使用距离来减少他们对令人沮丧的图片的情绪反应时的大脑活动，然后让他们接受距离策略的特定训练。训练结束后，我们将再次对他们进行功能磁共振成像扫描，以确定他们的大脑活动模式是否正常化，以及他们是否能够更好地减少对图片的负面反应。如果这是有效的，它将表明这种训练可以帮助BPD患者更好地调节他们的情绪，并将支持进一步发展和将距离训练纳入BPD患者心理治疗的计划。本研究的第二个目的是确定BPD患者在重新经历消极情境时（如大脑情绪警报系统活动增加所示）对消极情境越来越敏感的倾向，是否会像恐惧症患者那样随着更多的接触而减少，还是会继续增加。了解这一点可以帮助治疗师计划如何在BPD患者的心理治疗中最有效地处理令人不安的生活经历。这个项目代表了脑成像研究的重要一步，因为它应用了关于大脑活动模式的信息来开发心理治疗的新方法。它针对的是一种严重、普遍且难以治疗的疾病。

DESCRIPTION (provided by applicant): Borderline Personality Disorder (BPD) is a common psychiatric disorder found in approximately 2% to 6% of the population and 20% of hospitalized psychiatric patients. It is characterized by intense and rapid mood changes, self-destructive behavior, sucidality, and tumultuous relationships. It has proved very difficult to treat with either medications or psychotherapy. Suicide rates of approximately 10% have been reported. In additional to the emotional costs of the suffering experienced by borderline patients and their loved ones, BPD patients typically function at a level substantially below that of individuals with comparable intellect and they consume a disproportionate share of mental health resources. The difficulty controlling emotion, so central to the disorder, has proved a particularly difficult to treat. The present study utilizes the latest neuroimaging findings in BPD to generate new ideas for the psychotherapy of the disorder. This project builds upon our previous neuroimaging work, which has shown that when BPD patients try to control their emotions by employing a method that healthy people frequently use quite effectively-taking an emotional distance from what is upsetting-BPD patients are not able to quiet down the part of their brain that sends out emotional alarm signals. The objective of the present study is to determine whether giving BPD patients special training in using this healthy distancing stragegy can help them to improve their ability to regulate their emotions and return their brain activity to a more normal pattern. We will do this by using fMRI to record brain activity as BPD subjects try to use distancing to reduce their emotional reactions to upsetting pictures before any training, then to have them receive specific training in the distancing strategy. After this training we will again obtain an fMRI scan to determine whether their pattern of brain activation has normalized and whether they have been able to better reduce their negative reactions to the pictures. If this is effective, it will show that such training may help BPD patients better regulate their emotions and would support a program to further develop and incorporate distancing training into the psychotherapy of BPD patients. A second objective of the present study is to determine whether the tendancy of BPD patients to become increasingly sensitized to negative situations when they are re-experienced (as shown by increased activity of the brain's emotional alarm system), will reduce with additional exposure, as it does in patients with phobias, or will continue to increase. Knowing this can help the therapist plan how to most therapeutically approach disturbing life experiences in the psychotherapy of BPD patients. This project represents an important step in brain imaging research since it applies information learned about brain activity patterns to develop new approaches to psychotherapy. It addresses a serious, prevalent and difficult to treat disorder. PUBLIC HEALTH RELEVANCE: Borderline Personality Disorder (BPD), a prevalent psychiatric disorder found in approximately 2% to 6% of the population and 20% of hospitalized psychiatric patients, has proven quite treatment resistant. In additional to the 10% suicide rate, the emotional costs of the suffering experienced by borderline patients and their loved ones, BPD patients typically consume a disproportionate share of mental health resources. This study is innovative in applying new insights gained from fMRI neuroimaging of the brain to develop new approaches for the treatment of borderline personality disorder.