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首页> 外文期刊>JAMA psychiatry >Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: Randomized clinical trial
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Impact of cognitive behavioral therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs: Randomized clinical trial

机译：社交焦虑症认知行为疗法对阴性自我信念认知重新评估神经动力学的影响：随机临床试验

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IMPORTANCE: Cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) is thought to enhance cognitive reappraisal in patients with SAD. Such improvements should be evident in cognitive reappraisal-related prefrontal cortex responses. OBJECTIVE: To determine whether CBT for SAD modifies cognitive reappraisal-related prefrontal cortex neural signal magnitude and timing when implementing cognitive reappraisal with negative self-beliefs. DESIGN: Randomized clinical trial of CBT for SAD vs wait-list control group during a study that enrolled patients from 2007 to 2010. SETTING: University psychology department. PARTICIPANTS: Seventy-five patients with generalized SAD randomly assigned to CBT or wait list. INTERVENTION: Sixteen sessions of individual CBT for SAD. MAIN OUTCOME MEASURES: Negative emotion ratings and functional magnetic resonance imaging blood oxygen-level dependent signal when reacting to and cognitively reappraising negative self-beliefs embedded in autobiographical social anxiety situations. RESULTS: During reactivity trials, compared with wait list, CBT produced (1) greater reduction in negative emotion ratings and (2) greater blood oxygen-level dependent signal magnitude in the medial prefrontal cortex. During cognitive reappraisal trials, compared with wait list, CBT produced (3) greater reduction in negative emotion ratings, (4) greater blood oxygen level-dependent signal magnitude in the dorsolateral and dorsomedial prefrontal cortex, (5) earlier temporal onset of dorsomedial prefrontal cortex activity, and (6) greater dorsomedial prefrontal cortex-amygdala inverse functional connectivity. CONCLUSIONS AND RELEVANCE: Modulation of cognitive reappraisal-related brain responses, timing, and functional connectivitymay be important brain changes that contribute to the effectiveness of CBT for social anxiety. This study demonstrates that clinically applied neuroscience investigations can elucidate neurobiological mechanisms of change in psychiatric conditions.
机译：重要提示：针对社交焦虑症（SAD）的认知行为疗法（CBT）被认为可以增强SAD患者的认知评估。这种改善应该在与认知重新评估有关的前额叶皮层反应中显而易见。目的：确定具有负面自我信念的认知重估时，SAD的CBT是否能改变与认知重估相关的前额叶皮层神经信号强度和时序。设计：2007年至2010年招募患者的一项研究中，针对SAD与等待名单对照组的CBT的随机临床试验。地点：大学心理学系。参与者：75例一般性SAD患者随机分配至CBT或等待名单。干预：SAD的个人CBT会话为16次。主要观察指标：对自传社会焦虑状况中的负面自我信念做出反应并对其进行认知重新评估时，负面情绪等级和功能性磁共振成像对血氧水平的依赖性信号。结果：在反应性试验中，与等待清单相比，CBT在内侧前额叶皮层产生了（1）负面情绪等级降低更大和（2）血氧水平依赖性信号强度更大。在认知重新评估试验中，与等待清单相比，CBT产生了以下方面：（3）负面情绪等级的降低幅度更大;（4）背外侧和背侧前额皮质的血氧水平依赖性信号强度更大;（5）背侧前额叶的时间性发作较早皮层活动，以及（6）背背前额皮层-杏仁核功能连接相反。结论和相关性：认知重新评估相关的大脑反应，时机和功能连接性的调节可能是重要的大脑变化，有助于CBT对社交焦虑的有效性。这项研究表明，临床应用的神经科学研究可以阐明精神状况改变的神经生物学机制。

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