Department of Psychiatry, Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center Division of Public Psychiatry, MA, 02115, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA.
Psychol Med. 2022 Sep;52(12):2245-2254. doi: 10.1017/S0033291720004110. Epub 2020 Nov 13.
The ability to manage emotions is an important social-cognitive domain impaired in schizophrenia and linked to functional outcome. The goal of our study was to examine the impact of cognitive enhancement therapy (CET) on the ability to manage emotions and brain functional connectivity in early-course schizophrenia.
Participants were randomly assigned to CET ( = 55) or an enriched supportive therapy (EST) control group ( = 45). The resting-state functional magnetic resonance imaging scans and measures of emotion management performances were collected at baseline, 9, and 18 months follow-up. The final sample consisted of 37 CET and 25 EST participants, including 19 CET and 12 EST participants with imaging data. Linear mixed-effects models investigated the impact of treatment on emotion management and functional connectivity from the amygdala to ventrolateral and dorsolateral prefrontal cortex (dlPFC).
The CET group showed significant improvement over time in emotion management compared to EST. Neither functional connectivity changes nor main group differences were observed following treatment. However, a significant between-group interaction showed that improved emotion management ability was associated with increased functional connectivity between the left amygdala and the left dlPFC in the CET group exclusively.
Our results replicate the previous work demonstrating that CET is effective at improving some aspects of social cognition in schizophrenia. We found evidence that improvement in emotion management may be associated with a change in amygdala-dlPFC connectivity. This fronto-limbic circuit may provide a mechanistic link between the biology of emotion management processes that can be enhanced in individuals with schizophrenia.
情绪管理能力是精神分裂症患者受损的重要社会认知领域，与功能结果相关。我们的研究目的是探讨认知增强治疗（CET）对早期精神分裂症患者情绪管理能力和大脑功能连接的影响。
参与者被随机分配到 CET（n=55）或丰富支持性治疗（EST）对照组（n=45）。在基线、9 个月和 18 个月的随访时采集静息状态功能磁共振成像扫描和情绪管理表现的测量值。最终样本包括 37 名 CET 和 25 名 EST 参与者，其中 19 名 CET 和 12 名 EST 参与者具有影像学数据。线性混合效应模型探讨了治疗对情绪管理和杏仁核到腹外侧和背外侧前额叶皮质（dlPFC）的功能连接的影响。
CET 组在情绪管理方面的表现优于 EST 组，且随着时间的推移有显著改善。治疗后未观察到功能连接变化或主要组间差异。然而，显著的组间交互表明，情绪管理能力的改善与 CET 组左杏仁核与左 dlPFC 之间功能连接的增加有关。
我们的结果复制了之前的研究，表明 CET 能有效改善精神分裂症患者的某些社会认知方面。我们发现，情绪管理能力的改善可能与杏仁核-dlPFC 连接的变化有关。这个额-边缘回路可能为情绪管理过程的生物学提供了一个机制联系，而在精神分裂症患者中，这些过程是可以增强的。
