调节定向系统功能失调与抑郁-焦虑共病的关系：心理机制与干预研究

There is a high comorbidity prevalence between depressive and anxiety disorder. Comorbidity not only increased the patient's suffering, but also increased the difficulty of treatment. Recent studies showed that the Regulation Focused Theory, as one of the self-regulation theory, has strong explanatory power for the comorbidity of depression and anxiety and has great potential to translate into targeted psychological intervention. However, there is still a lack of enough clinical test on the causal relationship between dysfunction of the regulatory focus system and the occurrence of depression / anxiety symptoms. Furthermore, there is no systematic study on the interaction between attention, motivation and conscious self-control in the process of self-regulation. This study hypothesizes that promotion system (approach-oriented motivational system) dysfunction is associated with the development of depressive symptoms; prevention system (avoidance-oriented motivational systems) dysfunction is associated with the development of anxiety symptoms. The study would include cognitive behavioral experiments, longitudinal follow-up study, and randomized controlled intervention trials, using behavioral response time, eye tracking and multi-channel physiological signal acquisition technique to study the abnormal psycho-physiological mechanisms during the process of self-regulation systematically. This study would improve the psychopathological model of depression - anxiety comorbidity based on the self-regulation theory. The current study would also develop a targeted psycho-behavioral intervention method for depression / anxiety comorbidity patients based on the mechanism research.

抑郁症与焦虑症共病率非常高。共病不仅增加了患者的痛苦，而且提高了治疗的难度。最近研究表明，自我调节理论中的调节定向理论对抑郁症与焦虑症的共病具有较强的解释力，并有转化为靶点心理干预的巨大潜力。但目前对调节定向系统功能失调与抑郁/焦虑症状之间的因果关系，尚缺乏足够的临床检验，对自我调节过程中的注意、动机、以及有意识的自我控制之间的交互作用缺乏系统研究。本项目假设，促进定向系统（趋近导向的动机系统）的自我调节失败与抑郁症状的发生有关，预防定向系统（回避导向的动机系统）的自我调节失败与焦虑症状的发生有关。本项目拟采用认知行为实验、纵向跟踪研究、以及随机对照干预实验，借助行为反应时、眼动追踪以及多导生理信号采集等多种测量手段，对自我调节过程中的心理和生理异常机制进行系统研究，完善基于自我调节理论的抑郁-焦虑共病心理病理模型。基于机制研究，本课题将发展出针对抑郁/焦虑共病患者的靶点心理行为干预方法。

自我调节理论对抑郁症与焦虑症的发病均有一定的解释力，并有转化为靶点心理行为干预的潜力，但该理论的一些重要假设尚缺乏足够的临床检验；自我调节系统功能失调与情绪障碍之间的心理异常机制尚缺乏详细阐释，基于自我调节理论的心理行为干预也有待发展和检验。本项目围绕自我调节与抑郁、焦虑症状的发生发展之间的关系开展研究，主要取得了以下成果：（1）考察了自我调节定向与抑郁焦虑症状和自杀风险之间的关系，从而初步探明了自我调节定向理论对抑郁焦虑症状的解释力。（2）采用纵向跟踪研究设计和多变量分析，进一步检验了促进定向系统的自我调节失败与抑郁症状的发生发展，预防定向系统的自我调节失败与焦虑症状的发生发展之前的因果关系，在此基础上提出了基于自我调节理论的抑郁-焦虑及其共病的心理病理解释模型。（3）设计了两种本土化的心理行为干预方案，并检验其对于改善抑郁/焦虑症状的实际效果。（4）在更为广泛的人群中（例如服刑人员和大学生群体）进一步考察抑郁症和焦虑症的远端及近端心理社会发病因素，包括早年的心理创伤对成年后自我调节功能的影响，以及心理创伤对述情障碍、抑郁和焦虑症状、自杀风险等心理病理症状的影响路径。在本项目的资助下，目前已发表SCI/SSCI收录论文6篇，中文核心期刊论文9篇，以及1篇处于审稿过程中的论文。本项目的研究成果不仅有利于加深对抑郁症、焦虑症及自杀行为发生发展机制的理解，也可为抑郁症和焦虑症的心理干预提供新的思路和方法。