评价认知行为疗法与正念冥想在社交焦虑障碍患者再评价和接受过程中大脑变化的比较：一项随机临床试验。

Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial.

机构信息

University of California, Davis.

University of Southern California, Los Angeles.

出版信息

JAMA Psychiatry. 2021 Oct 1;78(10):1134-1142. doi: 10.1001/jamapsychiatry.2021.1862.

DOI:10.1001/jamapsychiatry.2021.1862

PMID:34287622

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8295897/

Abstract

IMPORTANCE

Cognitive behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR) are thought to help patients with social anxiety disorder (SAD) via distinct emotion-regulation mechanisms. However, no study has compared the effects of CBGT and MBSR on brain and negative emotion indicators of cognitive reappraisal and acceptance in patients with SAD.

OBJECTIVE

To investigate the effects of CBGT and MBSR on reappraisal and acceptance in patients with SAD and to test whether treatment-associated brain changes are associated with social anxiety symptoms 1 year posttreatment.

DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical trial, a total of 108 unmedicated adults diagnosed with generalized SAD were randomly assigned to 12 weeks of CBGT, MBSR, or waitlist. The final sample included 31 patients receiving CBGT, 32 patients receiving MBSR, and 32 waitlist patients. Data were collected at the psychology department at Stanford University from September 2012 to December 2014. Data were analyzed from February 2019 to December 2020.

INTERVENTIONS

CBGT and MBSR.

MAIN OUTCOMES AND MEASURES

Changes in self-reported negative emotion and functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal within an a priori-defined brain search region mask derived from a meta-analysis of cognitive reappraisal and attention regulation 1 year posttreatment.

RESULTS

Of 108 participants, 60 (56%) were female. The mean (SD) age was 32.7 (8.0) years. Self-reported race and ethnicity data were collected to inform the generalizability of the study to the wider population and to satisfy the requirements of the National Institutes of Health. From the categories provided by the National Institutes of Health, 47 participants selected White (43.5%), 42 selected Asian (38.9%) 10 selected Latinx (9.3%), 1 selected Black (1%), 1 selected Native American (1%), and 7 selected more than 1 race (6.5%). CBGT and MBSR were associated with a significant decrease in negative emotion (partial η2 range, 0.38 to 0.53) with no significant between-group differences when reacting (β, -0.04; SE, 0.09; 95% CI, -0.11 to 0.08; t92 = -0.37; P = .71), reappraising (β, -0.15; SE, 0.09; 95% CI, -0.32 to 0.03; t92 = -1.67; P = .10), or accepting (β, -0.05; SE, 0.08; 95% CI, -0.20 to 0.11; t92 = -0.59; P = .56). There was a significant increase in BOLD percentage signal change in cognitive and attention-regulation regions when reappraising (CBGT = 0.031; MBSR = 0.037) and accepting (CBGT = 0.012; MBSR = 0.077) negative self-beliefs. CBGT and MBSR did not differ in decreased negative emotion and increased reappraisal and acceptance BOLD responses. Reappraisal-associated MBSR (vs CBGT) negative emotions and CBGT (vs MBSR) brain responses were associated with social anxiety symptoms 1 year posttreatment.

CONCLUSIONS AND RELEVANCE

The results of this study suggest that CBGT and MBSR may be effective treatments with long-term benefits for patients with SAD that recruit cognitive and attention-regulation brain networks. Despite contrasting models of therapeutic change, CBT and MBSR may both enhance reappraisal and acceptance emotion regulation strategies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02036658.

摘要

重要性

认知行为团体治疗（CBGT）和基于正念的压力减轻（MBSR）被认为通过不同的情绪调节机制帮助社交焦虑障碍（SAD）患者。然而，尚无研究比较 CBGT 和 MBSR 对 SAD 患者的认知重评和接受的负面情绪指标以及大脑的影响。

目的

研究 CBGT 和 MBSR 对 SAD 患者的重评和接受的影响，并检验治疗相关的大脑变化是否与治疗后 1 年的社交焦虑症状相关。

设计、地点和参与者：在这项随机临床试验中，共有 108 名未经药物治疗的广泛性 SAD 成年患者被随机分配到 12 周的 CBGT、MBSR 或候补组。最终样本包括 31 名接受 CBGT 的患者、32 名接受 MBSR 的患者和 32 名候补组患者。数据于 2012 年 9 月至 2014 年 12 月在斯坦福大学心理学系采集。数据分析于 2019 年 2 月至 2020 年 12 月进行。

干预措施

CBGT 和 MBSR。

主要结果和测量

治疗后 1 年，使用预先定义的大脑搜索区域掩模内的自我报告负面情绪和功能磁共振成像（fMRI）血氧水平依赖性（BOLD）信号变化，该掩模源自认知重评和注意力调节的荟萃分析。

结果

在 108 名参与者中，60 名（56%）为女性。平均（SD）年龄为 32.7（8.0）岁。自我报告的种族和民族数据是为了说明研究对更广泛人群的普遍性，并满足美国国立卫生研究院的要求而收集的。根据美国国立卫生研究院提供的类别，47 名参与者选择了白人（43.5%），42 名选择了亚洲人（38.9%），10 名选择了拉丁裔（9.3%），1 名选择了黑人（1%），1 名选择了美洲原住民（1%），7 名选择了多种族（6.5%）。CBGT 和 MBSR 与负面情绪显著降低相关（部分 η2 范围，0.38 至 0.53），反应时无显著组间差异（β，-0.04；SE，0.09；95%CI，-0.11 至 0.08；t92 = -0.37；P = 0.71），重评（β，-0.15；SE，0.09；95%CI，-0.32 至 0.03；t92 = -1.67；P = 0.10）或接受（β，-0.05；SE，0.08；95%CI，-0.20 至 0.11；t92 = -0.59；P = 0.56）。当重新评估（CBGT = 0.031；MBSR = 0.037）和接受（CBGT = 0.012；MBSR = 0.077）消极自我信念时，认知和注意力调节区域的 BOLD 百分比信号变化增加。CBGT 和 MBSR 在减少负面情绪和增加重评和接受的 BOLD 反应方面没有差异。MBSR 与 CBGT 相比（vs CBGT）负性情绪和 CBGT 与 MBSR 相比（vs MBSR）大脑反应与治疗后 1 年的社交焦虑症状相关。