Introduction: Family caregivers of patients with dementia suffer a high burden of depression and reduced positive emotions. Mentalizing imagery therapy (MIT) provides mindfulness and guided imagery skills training to improve balanced mentalizing and emotion regulation. Objective: Our aims were to test the hypotheses that MIT for family caregivers would reduce depression symptoms and improve positive psychological traits more than a support group (SG), and would increase dorsolateral prefrontal cortex (DLPFC) connectivity and reduce subgenual anterior cingulate cortex (sgACC) connectivity. Methods: Forty-six caregivers participated in a randomized controlled trial comparing a 4-week MIT group (n = 24) versus an SG (n = 22). Resting state neuroimaging was obtained at baseline and post-group in 28 caregivers, and questionnaires completed by all participants. The primary outcome was change in depression; secondary measures included anxiety, mindfulness, self-compassion, and well-being. Brain networks with participation of DLPFC and sgACC were identified. Connectivity strengths of DLPFC and sgACC with respective networks were determined with dual regression. DLPFC connectivity was correlated with mindfulness and depression outcomes. Results: MIT significantly outperformed SG in improving depression, anxiety, mindfulness, self-compassion, and well-being, with moderate to large effect sizes. Relative to SG, participants in MIT showed significant increases in DLPFC connectivity – exactly replicating pilot study results – but no change in sgACC. DLPFC connectivity change correlated positively with mindfulness and negatively with depression change. Conclusions: In this trial, MIT was superior to SG for reducing depression and anxiety symptoms and improving positive psychological traits. Neuroimaging results suggested that strengthening DLPFC connectivity with an emotion regulation network might be mechanistically related to MIT effects.
Psychother Psychosom

中文翻译：

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家庭痴呆症护理人员为期 4 周的心智意象疗法：神经回路改变的随机对照试验

简介：痴呆症患者的家庭照顾者承受着沉重的抑郁负担和积极情绪的减少。心智意象疗法 (MIT) 提供正念和引导性意象技能训练，以改善平衡的心智化和情绪调节。目标：我们的目的是检验这样的假设，即家庭看护者的 MIT 比支持组 (SG) 更能减少抑郁症状和改善积极的心理特征，并且会增加背外侧前额叶皮层 (DLPFC) 的连通性并减少膝下前扣带皮层 (sgACC) ）连通性。方法： 46 名看护者参加了一项随机对照试验，比较 4 周 MIT 组（ n = 24）与 SG（ n= 22). 28 名护理人员在基线和分组后获得了静息状态神经影像，所有参与者都完成了问卷调查。主要结果是抑郁症的变化；次要措施包括焦虑、正念、自我同情和幸福感。确定了 DLPFC 和 sgACC 参与的脑网络。DLPFC 和 sgACC 与各自网络的连接强度通过对偶回归确定。DLPFC 连通性与正念和抑郁结果相关。结果：麻省理工学院在改善抑郁、焦虑、正念、自我同情和幸福感方面明显优于 SG，具有中到大的效果。相对于 SG，麻省理工学院的参与者显示 DLPFC 连通性显着增加——完全复制试点研究结果——但 sgACC 没有变化。DLPFC 连通性变化与正念正相关，与抑郁变化负相关。结论：在这项试验中，MIT 在减少抑郁和焦虑症状以及改善积极心理特征方面优于 SG。神经影像学结果表明，加强 DLPFC 与情绪调节网络的连接可能在机制上与 MIT 效应相关。
心理医生