激活右腹外侧前额叶提高抑郁症患者对社会疼痛的情绪调节能力：一项TMS研究

doi:10.3724/SP.J.1041.2021.00494

摘要/Abstract

摘要：

负性人际交往经历和负性社会事件是抑郁症的重要诱导因素, 而社会功能受损是抑郁症患者的重要特征之一, 患者通常表现出对社会疼痛的情绪失调。为了提高抑郁症患者在负性社交情境中或面对负性社会事件时的情绪调节能力, 本研究采用经颅磁刺激技术(transcranial magnetic stimulation, TMS), 考察抑郁症患者在腹外侧前额叶(the ventrolateral prefrontal cortex, VLPFC)被激活后其情绪调节能力的改变。结果表明, 当右侧VLPFC被TMS激活且患者采用认知重评策略调节情绪时, 实验组患者(n = 64)比对照组患者(n = 63)在社会排斥情境下报告了更弱的负性情绪体验, 这说明激活右侧VLPFC可以有效提高患者对社会疼痛的外显性情绪调节能力。本研究是采用TMS提高抑郁症患者情绪调节能力的首次尝试, 实验发现不但支持了VLPFC与认知重评策略的因果关系, 还为临床改善抑郁症等社会功能障碍患者的情绪调节能力提供了明确的神经治疗靶点。后续研究还需探讨多疗程TMS刺激方案、改变社会疼痛的诱发方式、对比左右侧VLPFC的治疗效果、尝试使用其他的情绪调节策略, 进一步验证本研究的结论, 优化TMS治疗方案。

关键词: 抑郁症, 经颅磁刺激, 腹外侧前额叶, 社会疼痛, 情绪调节

Abstract:

Increasing evidence shows that the right ventrolateral prefrontal cortex (rVLPFC) plays an important role in emotion regulation, especially for social-relevant negative emotions. Negative interpersonal experiences and social events contribute largely to the occurrence of depression. Meanwhile, patients diagnosed with major depressive disorder are characterized by impaired social functions. Previous studies have revealed that depressed patients frequently show impaired emotional regulation for social pain. Recently, the work of our lab found that using transcranial magnetic stimulation (TMS) to activate the rVLPFC significantly reduced the subjects’ negative emotional feelings and improved their emotional regulation ability for down-regulating social pain. In order to improve the emotional regulation ability in depressed patients when they are in front of negative social events, this study examined the changed emotional regulation ability in depression following the activation of the rVLPFC using the TMS.
A total of 127 patients who were diagnosed with major depressive disorder were recruited in this study. Participants were randomly assigned to experimental (n= 64) or control group (n = 63) while their age, gender, depressive level, social anxious level, rejection sensitivity and empathy ability were counterbalanced between the two groups. During the experiment, the participants were required to view pictures containing social exclusion events or reinterpret the situation using reappraisal strategy, followed by rating their negative emotional feeling on a 9-point scale. The experiment had two conditions, i.e., a passive viewing block and a cognitive reappraisal block.
The results showed that the main effect of the task was significant: the negative emotional intensity reported by participants was lower during cognitive reappraisal when compared to that during passive viewing, indicating a successful manipulation of explicit emotional regulation. Meanwhile, the main effect of the group was significant: the negative emotional intensity reported by the experimental group was significantly reduced compared to that reported by the control group, suggesting the critical role of rVLPFC in emotional regulation. More importantly, the interaction between task and group was significant: while the two groups reported comparable distressful feelings during the passive view block, the experimental group reported decreased negative feelings compared to the control group during the cognitive reappraisal block. This result indicated that enhanced activation of the rVLPFC could effectively improve the ability of explicit down-regulating social pain using the cognitive reappraisal strategy in depressed patients.
The current findings provide strong evidence for the causal relationship between the VLPFC and explicit emotional regulation using the cognitive reappraisal strategy. Also this study provides a potential neural target for clinical treatments of emotional regulation impairment in patients with social dysfunctions including individuals diagnosed with major depressive disorder, social anxiety disorder, and autism spectrum disorder. Future studies are suggested to use other paradigms (e.g., Cyberball, Chat Rooms, Online Ostracism, and Island Getaway) to induce a “first-hand” social pain and exclude the potential influence of empathy. Furthermore, optimized multi-session TMS protocols are required to enhance and prolong the TMS effects observed in this study. Also, the TMS-based treatment effects in depression should be compared between the left and the right part of the ventrolateral prefrontal cortices, and across different emotional regulation strategies including cognitive reappraisal, distraction, distancing, etc.

Key words: depression, transcranial magnetic stimulation, ventrolateral prefrontal cortex, social pain, emotion regulation

中图分类号:

B845
R395

莫李澄, 郭田友, 张岳瑶, 徐锋, 张丹丹. (2021). 激活右腹外侧前额叶提高抑郁症患者对社会疼痛的情绪调节能力：一项TMS研究. 心理学报, 53(5), 494-504.

MO Licheng, GUO Tianyou, ZHANG Yueyao, XU Feng, ZHANG Dandan. (2021). The role of ventrolateral prefrontal cortex on emotional regulation of social pain in depressed patients: A TMS study. Acta Psychologica Sinica, 53(5), 494-504.

图/表 4

表1 本研究两组患者的人口学特征(M ± SD)

变量	实验组 (n = 64)	对照组 (n = 63)	差异检验
年龄(岁)	29.0 ± 2.3	28.8 ± 2.7	t = 0.5, p= 0.593
性别(女/男)	34/30	33/30	χ² = 0.007, p= 0.933
抑郁 (BDI-II)	23.3 ± 6.5	22.3 ± 5.8	t = 0.9, p= 0.382
社交焦虑(LSAS)	39.4 ± 20.2	39.8 ± 20.3	t = -0.1, p= 0.911
拒绝敏感性(RSQ)	9.0 ± 3.4	8.8 ± 3.8	t = 0.3, p= 0.763
共情(IRI)	51.1 ± 9.7	49.4 ± 10.5	t = 1.0, p= 0.328

图1 实验材料及实验流程。A, 实验材料示例。本实验部分图片选自互联网, 为了不侵犯他人版权和肖像权, 此处图片中的人物为课题组研究生。B, 单个试次的刺激呈现内容。C, 实验流程图。

图2 TMS电流分布模拟图。图中的颜色代表了归一化的电流场强度, 蓝色表示0, 红色表示个体最大值。

图3 实验结果。A, 被动观看和认知重评过程中的负性情绪强度评分(1~9点评分, 1分表示最低强度的负性情绪, 9分表示最高强度的负性情绪)。B, 情绪调节30 min后的图片效价评分(1~9点评分, 1分表示最负性, 9分表示最正性)。图中的误差条表示均值的标准误。*p < 0.05。

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