Neurostimulation Enhanced Cognitive Restructuring for Transdiagnostic Emotional Dysregulation: A Component Analysis

情绪失调构成了一个严重的公共卫生问题，需要新的方法来 有效地以跨诊断方式解决这个问题。尽管情感和认知神经科学发展迅速， 将基本发现转化为新的干预措施的尝试很少。此外，该计划的关联性 情绪调节网络中的不同节点对精神病理和成功的情绪降压具有重要意义 唤醒还没有完全被理解。无创神经刺激，如重复经颅磁疗 刺激(RTMS)是一种强大的工具，可以通过调节 神经激活。因此，当前研究的目标是检查即刻的神经和行为 神经调节增强情绪调节训练后的变化 心烦意乱时很难平静下来。中心假说是神经刺激增强了 情绪调节技能的获得与情绪调节中神经功能的修复 网络。我们的长期目标是开发新的干预措施，利用神经科学的发现来推动 行为疗法。 本项目的主要目的是评估单节训练的独特神经和行为效果。 结合认知重建(CR)，一种情绪调节技能，与背外侧的兴奋性rTMS相结合 前额叶皮质(DlPFC)。第二个目标是确定情绪调节神经的关键变化 联合干预之后的网络与单独使用每个组件相比。第三个目标是探索 情绪调节训练反应的个性化生物标志物。为了实现这些目标，240个rtms天真， 符合情感性或应激性DSM-5障碍标准的社区成年人(不包括共同发生的厌食症， 酒精和药物使用、双相I型或精神障碍)，以及自我报告高度情绪失调的人 在经历情绪调节任务的同时，较少使用CR将参与大脑成像。参与者 将被随机分配到CR培训(组1和组2)或关于情绪的心理教育(组3；目标 对非特定因素进行控制)。参与者将被提醒最近的压力源，并将经历真实的 (组1和组3)或假手术(组2)，使用fMRI结果作为靶点。参与者了解到 CR将在一次性的rTMS期间练习这项技能，并将监测生理唤醒 贯穿于情绪诱导和调控的实践中。在这次培训之后，参与者将接受 另一次功能扫描和离职面谈，以评估即刻的神经和行为变化。生物- 情绪调节的行为测量将在一周和一个月的随访中进行评估。如果 如果成功，我们的研究将为开发一种新的跨诊断技术提供关键的机制信息 情感和应激障碍的治疗。

Emotional dysregulation constitutes a serious public health problem and novel approaches are needed to effectively address it transdiagnostically. Despite rapid advancements in affective and cognitive neuroscience, there have been few attempts to translate basic findings into novel interventions. In addition, the relevance of different nodes in the emotion regulation network to psychopathology and to successful reduction of emotional arousal is not yet fully understood. Noninvasive neurostimulation, such as repetitive transcranial magnetic stimulation (rTMS), is a powerful tool with which dysfunction can be alleviated temporarily, by modulating neural activation. Therefore, the objective of the current study is to examine immediate neural and behavioral changes following neuromodulation enhanced emotion regulation training for transdiagnostic adults who report difficulties calming down when upset. The central hypothesis is that neurostimulation enhances the acquisition of emotion regulation skills and leads to remediated neural function in the emotion regulation network. Our long-term goal is to develop novel interventions that harness neuroscientific findings to advance behavioral treatments. The primary aim of this project is to evaluate the unique neural and behavioral effects of a one-session training combining cognitive restructuring (CR), an emotion regulation skill, with excitatory rTMS over the dorsolateral prefrontal cortex (dlPFC). The secondary aim is to identify key changes in the emotion regulation neural network following the combined intervention versus each of the components alone. The third aim is to explore personalized biomarkers for response to emotion regulation training. To achieve these aims, 240 rTMS naïve, community adults who meet criteria for affective or stress DSM-5 disorders (excluding if co-occurring anorexia, alcohol and substance use, bipolar I, or psychotic disorders) and who self-report high emotional dysregulation and low use of CR will participate in brain imaging while undergoing an emotional regulation task. Participants will be randomly assigned to CR training (groups 1 & 2) or to psychoeducation about emotions (group 3; aimed to control for nonspecific factors). Participants will be reminded of recent stressors and will undergo real (groups 1 & 3) or sham (group 2) high frequency rTMS, targeted using fMRI results. Participants who learned CR will practice this skill during rTMS in a one-time session, and physiological arousal will be monitored throughout the emotion induction and regulation practice. Following this training, participants will undergo another functional scan and an exit interview to assess for immediate neural and behavioral changes. Bio- behavioral measures of emotion regulation will be assessed at a one week and a one month follow up visit. If successful, our line of research will provide key mechanistic information to develop a novel transdiagnostic treatment for affective and stress disorders.