George Washington University, School of Medicine, Bipolar Collaborative Network, 5415 W. Cedar Lane Suite 201-B, Bethesda, MD 20814, USA.
Harvard University, Graduate School of Education, 205 Longfellow Hall, Appian Way, Cambridge, MA 02138, USA.
Psychiatry Res. 2017 Mar;249:327-336. doi: 10.1016/j.psychres.2017.01.034. Epub 2017 Jan 20.
Stressors may initially precipitate affective episodes, but with sufficient numbers of recurrences, episodes can occur more autonomously. It is postulated the memory engram for these recurrent depressions moves from the conscious representational memory system to the unconscious habit memory system encoded in the striatum. If this were the case, cognitive behavior therapy targeted toward extinction of habit memories could be an effective maneuver for helping reverse the automaticity of affective episode recurrence. Extinction training in the reconsolidation window (which opens about 5min to 1h after active memory recall) can revise, reverse, or eliminate the long term memories associated with PTSD and other anxiety disorders and with drug abuse craving. We hypothesize that similar cognitive behavioral work in the reconsolidation window could inhibit stress-induced and spontaneous affective episodes. Some initial formulations of possible therapeutic strategies are presented and discussed, as well as caveats. It is hoped that preliminary exposition of this theoretical approach to recurrences in the affective disorders based on principles dependent on work in the reconsolidation window will lead to more detailed elaboration of the therapeutic maneuvers most likely to be successful and ones that can be specifically tested for their clinical efficacy.
应激源最初可能引发情感发作，但随着发作次数的增加，发作可能变得更加自主。据推测，这些反复发作的抑郁症的记忆印痕从有意识的表象记忆系统转移到纹状体中编码的无意识习惯记忆系统。如果是这样，针对习惯记忆消除的认知行为疗法可能是一种有效的手段，可以帮助逆转情感发作复发的自动性。在再巩固窗口（在主动记忆回忆后约 5 分钟到 1 小时打开）进行的消退训练可以修改、逆转或消除与创伤后应激障碍和其他焦虑障碍以及药物滥用渴望相关的长期记忆。我们假设，在再巩固窗口进行类似的认知行为工作可以抑制应激诱导和自发性情感发作。本文提出并讨论了一些可能的治疗策略的初步构想，并提出了一些注意事项。希望基于再巩固窗口工作原理的情感障碍复发的这一理论方法的初步阐述，将导致对最有可能成功的治疗手段的更详细阐述，并可以针对其临床疗效进行具体测试。
