Isolating Mechanisms in the Treatment of Borderline Personality Disorder

 描述(由申请人提供)：边缘性人格障碍(BPD)是一种常见的、严重的和昂贵的疾病，其治疗努力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，主要集中在解决危及生命的调节失调，这是这种疾病的特征。然而，值得注意的是，大多数被诊断为BPD的人从未试图自杀或需要住院治疗。对于BPD程度较轻的患者来说，多成分干预可能不是最有效的方法，也使人们很难得出结论，说明哪些治疗策略影响了维持症状的机制。此外，现有的BPD治疗方法没有明确解决焦虑和抑郁障碍的高共病比率；这些障碍之间的高水平共同出现突显了确定与维持跨越诊断边界的机制相关的跨诊断治疗组件的有效性。拟议的以患者为导向的导师研究职业发展奖(K23)是一项为期四年的计划，旨在支持申请者的长期职业目标，即成为一名临床科学家，擅长开发节俭、易于传播的治疗BPD和其他情绪障碍的疗法。K23奖项的直接目标是让申请者掌握一些旨在隔离障碍影响和治疗机制的方法方法。申请者到目前为止的培训和发展支持了这些长期目标。在她的整个研究生工作中，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。这项拟议研究的具体目标是分离行为与情绪驱动的行动倾向不一致的独特影响，情绪驱动的行动倾向是BPD、焦虑和抑郁障碍的主要治疗方法中包括的一个治疗成分。该项目将分两个阶段完成。第一阶段的目标是根据实验治疗学的方法，在单病例实验(交替治疗设计)的背景下，在被诊断为BPD的个体样本中调查与情绪驱动的行为冲动不一致的行为对情绪强度的影响。第二阶段还将利用单病例实验设计(在本案例中为多基线研究)，在诊断为BPD的样本中，探索仅专注于与情绪行为倾向不一致的短暂干预对情绪强度、情绪耐受性和BPD症状的影响。培训计划与拟议的研究和长期目标密切匹配，重点是培训活动，以促进候选人作为独立调查员的发展。具体地说，培训的目的是：(1)加深对研究方法的深入了解，以调查行为治疗中假定的作用机制(例如，单病例实验设计、统计方法)；(2)获得针对BPD人群的研究方法的经验(例如，诊断和临床变化评估、招募和保留策略)；(3)加强对临床目标和结果的多模式评估(例如，行为评估)的培训。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。所有研究和大部分培训活动都将在这里进行。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治疗的需要。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、更具成本效益和更容易传播的治疗策略，BPD是一种严重的、未被研究的疾病。

 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.