Cognitive Training for Emotion Regulation in Psychotic Disorders

项目摘要 精神障碍是严重的和使人衰弱的精神疾病，给病人带来巨大的痛苦 对我们的医疗体系构成了重大挑战。情绪调节困难（即，的能力 控制情绪反应的策略）显著预测发展和维持 精神病症状和不良的社区功能结果。最近的神经影像学研究表明 额叶功能减退可能是这些缺陷的基础。不幸的是，没有公认的补救技术 这些情绪调节的异常。认知领域的最新进展 神经科学提供了解决精神障碍治疗中这一关键未满足需求的希望， 证明简短的计算机认知训练干预能够改善情绪， 调节能力的目标神经激活在前额叶皮层。拟议项目的目标是 确定情绪工作记忆（eWM）认知训练计划是否有效， 治疗精神病患者的情绪调节异常和相关临床结果 紊乱在R61阶段，患有精神障碍的门诊患者将被随机分配到eWM组， （n = 20）或安慰剂（P：n = 20）通过智能手机上的应用程序提供认知训练对照干预， 20天R61阶段的主要目的是确定eWM干预是否成功地 的目标机制，并增强前额叶激活的非训练情绪调节转移任务 超过预先规定的效应量标准。R61的结果也将用于确定治疗 模态（即，仅音频、仅视频或视听结合）和持续时间（10天与20天）， 有效和高效地提高了目标。R33的目标是进行初始随机化 R61中确定的最佳治疗的对照试验（RCT）。R33的具体目标是：1）复制 并扩展了R61结果，支持在一项充分功率的RCT中的前额叶目标参与（n = 80，40 eWM，40 P训练）; 2）确定目标参与是否与改善的近端结果相关 真实世界的情绪调节能力（通过生态瞬间的计算模型索引） 评估数据）和改善的阳性症状、阴性症状、功能 结果和神经认知。如果R33假设得到证实，结果将为以后的设计提供信息。 RCT用于精神病的早期阶段，并朝着精确医学的方向发展， 个人最有可能从干预中受益。

Project Summary Psychotic disorders are serious and debilitating mental illnesses that incur substantial suffering for patients and present major challenges to our health care system. Difficulties with emotion regulation (i.e., the ability to control the emotion response using strategies) significantly predict the development and maintenance of psychotic symptoms and poor community-based functional outcomes. Recent neuroimaging research indicates that hypofrontality may underlie these deficits. Unfortunately, there is no accepted technique for remediating these emotion regulation abnormalities in psychotic disorders. Recent advances from the field of cognitive neuroscience provide hope for a resolution to this critical unmet need in psychotic disorder therapeutics, demonstrating that brief computerized cognitive training interventions are capable of improving emotion regulation ability by targeting neural activation in the prefrontal cortex. The goal of the proposed project is to determine whether an emotional working memory (eWM) cognitive training program is effective for remediating emotion regulation abnormalities and associated clinical outcomes in people with psychotic disorders. In the R61 phase, outpatients with psychotic disorders will be randomly assigned to either an eWM (n = 20) or placebo (P: n = 20) cognitive training control intervention delivered via an app on a smartphone for 20 days. The primary aim of the R61 phase is to determine whether the eWM intervention successfully engages the target mechanism and enhances prefrontal activation on a non-trained emotion regulation transfer task beyond a pre-specified effect size criterion. Results of the R61 will also be used to determine the treatment modality (i.e., audio-only, visual-only, or combined audio-visual) and duration (10 vs. 20 days) that most effectively and efficiently improves the target. The goal of the R33 is to conduct an initial randomized controlled trial (RCT) of the optimal treatment identified in the R61. The R33 specific aims are to: 1) replicate and extend the R61 results supporting prefrontal target engagement in an adequately powered RCT (n = 80, 40 eWM, 40 P training); 2) determine if target engagement is associated with a proximal outcome of improved real-world emotion regulation ability (indexed via computational modeling of ecological momentary assessment data) and distal clinical outcomes of improved positive symptoms, negative symptoms, functional outcome, and neurocognition. If the R33 hypotheses are confirmed, results will inform the design of a later RCT for the early stages of psychosis, and to move toward a precision medicine approach that identifies which individuals are most likely to benefit from the intervention.