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规避行为的生理病理机制及重复经颅磁刺激作为其干预手段的应用前景分析

Avoidance: Its Physiological and Pathophysiological Mechanisms and Advances in Interventional Modalities

中国心理学前沿 / 2019,1(3)：202-220 / 2019-05-31 6315 9266

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• 作者： 李尹娇枝¹²      郑怡航¹²      马青坪¹²      李思婉¹²      顾祎文¹²      王继军¹      李春波¹      张宾¹³     
• 单位：

  1. 上海交通大学医学院附属卫生中心，上海，200025；
  2. 上海交通大学医学院，上海，200030；
  3. 广州医科大学附属脑科医院，广州市惠爱医院，广州，51037

• 关键词： 规避行为；机制；干预；重复经颅磁刺激
• Avoidance behavior; Mechanisms; Intervention; Repetitive transcranial magnetic stimulation (rTMS)
• 摘要： 规避行为是一种通过采取或不采取某种行为，避免不利刺激和事件的适应性策略。适度的规避行为有利于生物规避风险，节省能量，从而有利于生存，而过度或无法正常消除的规避行为不仅与多种心理或精神疾病的发生有关，还会对它们的症状和预后产生不良影响。本文回顾了近几年关于规避行为的形成及生理病理机制的研究成果，发现其形成与调节涉及多个脑区和条件反射机制，而其异常则涉及脑部器质性改变和行为学上的异常。通过对现有异常规避行为干预手段的发展现状及不足的分析，表明了新型干预方式的发展空间。在此基础上，从重复经颅磁刺激（rTMS）的发展和应用现状、前额叶对规避行为所起的调节作用和既往研究成果三个方面对利用低频重复经颅磁刺激减少异常规避行为的可行性进行了分析，分析结果表明，rTMS作为对异常规避行为的干预手段具有一定前景，对此进行后续研究具有一定价值。
• Avoidance behavior is an adaptive strategy of animals to cease the occurrence of adverse events by facilitating or not facilitating certain actions. Driven by the reward-related processing and fear conditioning, moderate avoidance behavior is essential to the survival of organisms as it helps to hedge risks and save energy. On the other hand, maladaptive avoidance behavior, which individuals over-generate or unable to remove is often associated with psychiatric disorders, and what’s more worsen the condition and affect the treatment. Reflecting on the recent researches on avoidance forming and its physiological and pathological mechanisms, this paper demonstrated that as it was the combination of logic decision-making and adaptive fear guided the arise of avoidance, its acquisition and regulation involved multiple brain areas serving in the reward and punishment system, as well as different conditioned reflexes. The maladaptation of avoidance behavior is often caused by organic changes of the brain and associated with behavioral abnormalities. This paper summarized the current intervention on avoidance behavior, and found such techniques inadequate. Then analyzed the feasibility of reducing maladaptive avoidance through low- frequency repetitive transcranial magnetic stimulation (rTMS) based on 3 aspects: ① its principles, development and applications, ② the role of the prefrontal cortex (PFC) in avoidance regulation, ③ previous work on interfering avoidance through rTMS on the PFC. In the end, this paper demonstrated an outlook of facilitating low-frequency TMS as an intervention on maladaptive avoidance and the value of conducting follow-up studies.
• DOI： https://doi.org/10.35534/pc/0103014
• 引用： 李尹娇枝，郑怡航，马青坪，等．规避行为的生理病理机制及重复经颅磁刺激作为其干预手段的应用前景分析［J］. 中国心理学前沿，2019，1（3）：202-220.
  https://doi.org/10.35534/pc/0103014