Isolating Mechanisms in the Treatment of Borderline Personality Disorder

 描述（由申请人提供）：边缘型人格障碍（BPD）是一种常见的、严重的、昂贵的疾病，治疗工作受到几个因素的阻碍。首先，BPD的现有治疗是长期的，密集的，由多个组成部分组成，主要集中在解决这种疾病特征的危及生命的失调。然而，值得注意的是，大多数被诊断患有BPD的人从未试图自杀或需要住院治疗。对于BPD严重程度较低的患者，多组分干预可能不是最有效的方法，并且难以得出关于哪些治疗策略影响维持症状的机制的结论。此外，现有的BPD治疗没有明确解决与焦虑和抑郁障碍的高共病率;这些疾病之间的高水平共病强调了识别跨诊断治疗成分的效用，这些成分与维持跨诊断边界的机制相关。拟议的指导以患者为导向的研究职业发展奖（K23）是一项为期四年的计划，旨在支持申请人的长期职业目标，成为一名精通开发简约，易于传播的BPD和其他情绪障碍治疗方法的临床科学家。K23奖的直接目标是让申请人熟练掌握一些旨在隔离疾病和治疗机制的影响的方法。迄今为止，申请人的培训和发展支持了这些长期目标。在她的研究生工作中，她进行了旨在确定维持情绪障碍症状的因素的研究，并利用这些信息对针对这些因素的治疗策略进行了几次小规模调查。拟议研究的具体目标是隔离与情绪驱动的行动倾向不一致的行动的独特效果，这是BPD，焦虑和抑郁障碍的主要治疗方法中的一个治疗成分。该项目将分两个阶段完成。第一阶段的目标，与实验治疗方法一致，是在单一病例实验（交替治疗设计）的背景下，研究与情绪驱动的行为冲动不一致的行为对诊断为BPD的个体样本中情绪强度的影响。第二阶段还将采用单一病例实验设计（在这种情况下是多基线研究），以探索在诊断为BPD的样本中，仅关注与情绪行为倾向不一致的行为的短暂干预对情绪强度、情绪耐受性和BPD症状的影响。培训计划密切配合拟议的研究和长期目标，重点是培训活动，以促进候选人发展成为独立调查员。具体而言，培训的目的是：（1）发展对研究方法的深入理解，旨在调查行为治疗中的假定作用机制（例如，单一病例实验设计，统计方法）;（2）获得BPD人群特定研究方法的经验（例如，诊断和临床变化评估，招募和保留策略）;（3）加强临床目标和结果多模式评估的培训（例如，行为评估）。波士顿大学焦虑和相关疾病中心是一家世界知名的临床研究机构，在治疗开发研究方面有着成功的历史。总体而言，这些研究和培训目标的更广泛目标是解决改善BPD治疗的需求。这项研究将回答有关治疗变化机制的重要理论问题，并可能导致更有效，更具成本效益，易于传播的治疗策略，BPD，一种严重的和未充分研究的疾病。

 DESCRIPTION (provided by applicant): Borderline personality disorder (BPD) is a commonly occurring, severe, and costly condition for which treatment efforts have been hindered by several factors. First, extant treatments for BPD are long-term, intensive and consist of multiple components, largely focused on resolving the life-threatening dysregulation that characterizes this disorder. It is important to note, however, that most individuals diagnosed with BPD never attempt suicide or require inpatient hospitalization. Multi-component interventions may not be the most efficient approach for patients with less severe levels of BPD and also make it difficult to draw conclusions regarding which treatment strategies are influencing mechanisms maintaining symptoms. Additionally, extant BPD treatments do no explicitly address high rates of comorbidity with anxiety and depressive disorders; high levels of co-occurrence amongst these disorders underscores the utility of identifying transdiagnostic treatment components relevant to maintaining mechanisms across diagnostic boundaries. The proposed Mentored Patient-Oriented Research Career Development Award (K23) is a four-year plan in support of the applicant's long-term career goal to become a clinical scientist proficient in developing parsimonious, easily disseminated treatments for BPD and other emotional disorders. The immediate goal of the K23 award is for the applicant to become skilled at a number of methodological approaches aimed at isolating the effects of disorder and treatment mechanisms. The applicant's training and development thus far has supported these long-term goals. Throughout her graduate work, she conducted studies aimed at identifying factors that maintain emotional disorder symptoms and used this information to conduct several small-scale investigations of treatment strategies targeting such factors. The specific goal of the proposed research study is to isolate the unique effect of acting inconsistent to emotion-driven action tendencies, a treatment component included in leading treatments for BPD, anxiety and depressive disorders. This project will be completed in two phases. The goal of Phase I, in line with an experimental therapeutics approach, is to investigate the effect of acting inconsistent with emotion-driven behavioral urges on emotional intensity in a sample of individuals diagnosted with BPD in the context of a single-case experiment (alternating treatment design). Phase II will also utilize single-case experimental design (in this case a multiple baseline study) to explore the effects of brief intervention focused solely on acting inconsistent to emotional action tendencies on emotional intensity, tolerance of emotions, and BPD symptoms in a sample diagnosed with BPD. The training plan closely matches the proposed research and long-term goals with an emphasis on training activities that will facilitate the candidate's development as an independent investigator. Specifically, the training aims are to: (1) Develop advanced understanding of research methodology aimed at investigating putative mechanisms of action in behavioral treatments (e.g., single-case experimental design, statistical methods); (2) Gain experience in research methodology specific to a BPD population (e.g. diagnostic and clinical change assessment, recruitment and retention strategies); (3) Enhance training in multi-modal assessment of clinical targets and outcomes (e.g., behavioral assessment). Boston University's Center for Anxiety and Related Disorders, where all research and the bulk of the training activities will take place, is a world-renown clinical research institution with a successful history of treatment development research. Overall, the broader aim of these research and training goals is to address the need for improved treatments for BPD. This study will answer important theoretical questions about the mechanism of treatment change, and might lead to more efficacious, cost-effective, and easily disseminable treatment strategies for BPD, a severe and understudied disorder.