Neurocognitive and Neurobehavioral Mechanisms of Change following Psychological Treatment for Alcohol Use Disorder

酒精使用障碍心理治疗后的神经认知和神经行为变化机制

• 批准号: 10380152
• 负责人: Eric D Claus
• 金额: $ 52.23万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-05 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10380152
• 关键词: Address; Affect; Aftercare; Alcohol abuse; Alcohol consumption; Alcohols; Amygdaloid structure; Arousal; Basic Science; Behavior Control; Behavior assessment; Behavioral; Behavioral Mechanisms; Characteristics; Client; Clinical Trials; Cognitive Therapy; Communities; Corpus striatum structure; Cues; Data; Development; Early treatment; Emotional; Functional Magnetic Resonance Imaging; Future; Goals; Heavy Drinking; Individual; Knowledge; Lateral; Lead; Measures; Medial; Mediating; Mindfulness Training; Modeling; Modification; Motivation; Neurocognitive; Outcome; Participant; Patient Self-Report; Patients; Pattern; Performance; Predictive Factor; Process; Public Health; Randomized; Randomized Clinical Trials; Recovery; Regulation; Relapse; Reporting; Research; Rewards; Sampling; Techniques; Testing; Time; Treatment outcome; Vision; Work; alcohol abstinence; alcohol abuse therapy; alcohol cue; alcohol use disorder; base; behavior change; blood oxygenation level dependent response; cognitive change; cognitive control; cognitive enhancement; comparison group; craving; cue reactivity; design; drinking; drinking behavior; effective therapy; executive function; falls; improved; individualized medicine; meetings; negative affect; neural network; neurobehavioral; neuroimaging; neuromechanism; novel; performance based measurement; psychologic; public health relevance; recruit; response; secondary analysis; skills; treatment group

Description: Although modestly effective treatments exist for alcohol use disorders (AUD), many individuals relapse to heavy alcohol use after completing treatment, suggesting the need for a better understanding of factors that contribute to successful outcomes. Whereas much of the focus in past studies has been on identifying what treatments work for AUDs, only recently has there been a focus on why particular treatments work, and the mechanisms by which treatment leads to changes in drinking. This focus on mechanisms of behavior change (MOBCs) has the potential to not only allow for an accumulation of knowledge about the process by which treatment leads to better outcomes, but also may lead to the development of new treatments or modifications of existing treatment approaches that target empirically supported mechanisms known to lead to change. Existing research has focused on potential mechanisms including alcohol cue reactivity, affect regulation, and behavioral control, but these constructs have largely been tested using self-report measures, and there is a noticeable paucity of studies that examine these mechanisms from a neurocognitive perspective. To address this gap in knowledge, the proposed study will examine MOBC at multiple levels including self- report, behavioral performance, and neural network engagement, with a focus on the function of the lateral and medial frontal control networks, striatal based reward networks, and amygdala networks underlying emotional reactivity. One hundred eighty treatment-seeking individuals with an AUD will be randomized to receive either 8 weeks of Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after receiving 4 weeks of a platform treatment that focuses on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in these MOBCs, patients will be assessed at: (a) baseline; (b) four weeks into treatment; (c) immediately post-treatment; and (d) 9- and 15-months post- baseline. Self-report measures and behavioral tasks will be administered at monthly intervals during treatment; and fMRI will be collected at baseline, and at 3, and 9-months post baseline. Relationships between changes in drinking and changes in the proposed MOBCs will be examined using advanced mixed modeling techniques that have been pioneered by the research team. Further, the project will leverage data collected in a separate project examining MOBC in a non-treatment seeking sample using the same measures collected at similar timepoints. By identifying MOBCs of CBT or MBT that differentially contribute to changes in drinking, the proposed project will not only derive a deeper understanding of successful behavior change, but also may inform the development of novel treatments for AUD. In addition, by identifying neurocognitive factors predictive of successful change, it may be possible to utilize this knowledge to match specific treatments with particular patient neurocognitive profiles.

描述：虽然对于酒精使用障碍 (AUD) 存在适度有效的治疗方法，但许多人 完成治疗后复发大量饮酒，表明需要更好地了解 促成成功结果的因素。尽管过去研究的大部分重点都集中在 确定哪些治疗方法对 AUD 有效，直到最近才开始关注为什么特定治疗方法 工作，以及治疗导致饮酒改变的机制。本次重点关注机制 行为改变（MOBC）不仅有潜力积累有关行为的知识 治疗带来更好结果的过程，但也可能导致新疗法的开发 或对现有治疗方法进行修改，以已知的经验支持机制为目标 改变。现有的研究重点关注潜在机制，包括酒精提示反应性、影响 监管和行为控制，但这些结构很大程度上已经通过自我报告措施进行了测试， 而且从神经认知角度审视这些机制的研究明显很少。 为了解决这一知识差距，拟议的研究将从多个层面检查 MOBC，包括自我评估 报告、行为表现和神经网络参与，重点关注横向和横向的功能 内侧额叶控制网络、基于纹状体的奖励网络和情绪底层的杏仁核网络 反应性。一百八十名持有 AUD 寻求治疗的个人将被随机分配接受 接受 4 后 8 周的认知行为治疗 (CBT) 或正念治疗 (MBT) 为期数周的平台治疗，重点是增强变革的动力。建立时态 饮酒变化与这些 MOBC 变化之间的关系，将在以下方面对患者进行评估：(a) 基线； (b) 治疗四个星期； (c) 治疗后立即； (d) 9个月和15个月后 基线。治疗期间将每月进行一次自我报告措施和行为任务； fMRI 将在基线时以及基线后 3 个月和 9 个月时收集。变化之间的关系 将使用先进的混合建模技术来检查饮酒和拟议 MOBC 的变化 这是研究小组首创的。此外，该项目将利用在单独的项目中收集的数据 项目在非治疗寻求样本中检查 MOBC，使用在类似情况下收集的相同措施 时间点。通过识别 CBT 或 MBT 中对饮酒变化有不同贡献的 MOBC， 拟议的项目不仅可以更深入地了解成功的行为改变，而且还可以 为 AUD 新疗法的开发提供信息。此外，通过识别神经认知因素 预测成功的改变，可以利用这些知识来匹配特定的治疗方法 特定患者的神经认知特征。