Repetitive Transcranial Magnetic Stimulation Augmented Written Exposure Therapy for Veterans with PTSD

针对患有 PTSD 的退伍军人的重复经颅磁刺激增强书面暴露疗法

• 批准号: 10402838
• 负责人: Crystal Lantrip
• 金额: --
• 依托单位: OLIN TEAGUE VETERANS CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402838
• 关键词: Affect; Affective; Affective Symptoms; Appointment; Area; Attention; Award; Behavior Therapy; Behavioral Mechanisms; Brain; Centers of Research Excellence; Clinic; Clinical; Clinical Treatment; Clinical Trials; Cognition; Cognitive; Collaborations; Dedications; Diagnosis; Diagnostic; Dose; Double-Blind Method; Down-Regulation; Effectiveness; Electromagnetics; Emotional; Emotions; Fellowship; Freedom; Future; Goals; Healthcare; Individual Differences; Intervention; Investigation; Length; Magnetism; Mediating; Mediator; Mental Depression; Mental Health; Mental disorders; Mentors; Mission; Neurons; Outcome; Patients; Phase; Physiologic pulse; Positioning Attribute; Post-Traumatic Stress Disorders; Postdoctoral Fellow; Prefrontal Cortex; Process; Property; Psychotherapy; Quality of Care; Randomized; Randomized, Controlled Trials; Research; Research Personnel; Sampling; Scalp structure; Site; Stimulus; Symptoms; Testing; Time; Training; Trauma; Treatment Effectiveness; Treatment Protocols; Treatment outcome; Up-Regulation; Veterans; War; Woman; Work; Writing; behavioral study; brain based; brain behavior; care burden; career; cognitive control; cognitive enhancement; effective intervention; effective therapy; emotion dysregulation; emotion regulation; evidence base; experience; flexibility; improved; men; neural; neuromechanism; novel; operation; reduce symptoms; repetitive transcranial magnetic stimulation; symptomatic improvement; theories; trauma exposure; treatment effect; treatment-resistant depression

Post-traumatic stress disorder (PTSD) is highly prevalent among post-deployment Veterans. First line evidence-based psychotherapies (EBPs) for PTSD can be effective, but have limitations including high attrition rates, due in part to lengthy treatment protocols, and continued diagnosis of PTSD in a significant number of patients despite treatment completion. Alternate brain-based treatments are thus being explored, like repetitive transcranial magnetic stimulation (rTMS ), which is useful for depression and shows promise for PTSD. rTMS involves applying a repetitive, brief magnetic pulse to the scalp in order to safely modulate cortical neurons via the dorsolateral prefrontal cortex node, which is believed to improve control of cognition and emotions. Standard rTMS treatments are stand-alone, though the unique properties of rTMS enhancing cognitive control may make it more effective when added to an EBP for PTSD. A brief EBP for PTSD that is effective in as few as five sessions with limited attrition is written exposure therapy (WET). Integration of rTMS with WET could improve efficacy by improving emotional control-dependent cognitive restructuring, which is believed to be WET’s mechanism of action. However, this possibility has not been tested. The applicant, Dr. Lantrip, is a clinical neuropsychologist with expertise in brain -behavior relationships. She has significant experience studying behavioral and neural regulatory processes impacting mental health. Through her postdoctoral fellowship, she developed a theoretical framework for understanding the emotion regulatory mechanisms contributing to symptom improvement in rTMS for depression. She tested this theory in an rTMS clinical trial. Through her current primary VA appointment at the VISN 17 Center of Excellence for Research on Returning War Veterans, Dr. Lantrip has access to a large pool of Veterans with PTSD as well as to a research-dedicated TMS machine. Further, Dr. Lantrip has established collaborations with external researchers who are experts in rTMS treatment in Veterans and in WET. In short, Dr. Lantrip is in an ideal position to conduct the necessary research to augment behavioral therapy for PTSD with rTMS. In the proposed randomized controlled trial, Dr. Lantrip will compare active rTMS added to WET with sham rTMS added to WET in [98] Veterans with PTSD. She will also determine the mechanism of action of the treatment by determining if emotional flexibility is a mediator of treatment outcome. In summary, this project will attempt to augment WET, a brief EBP for PTSD, by adding rTMS, and it will also attempt to determine the emotion regulatory mechanism of action for symptom improvement. If successful, this work will influence both clinical treatment and scientific investigation of PTSD. This project will be of potentially great value to both patients and clinicians within the VA by providing an effective, efficient treatment option for veterans with PTSD. This treatment may also facilitate symptom improvement in transdiagnostic mental health disorders. Upon successful completion of this project, Dr. Lantrip will apply for a VA Merit Review Award with continued investigation into TMS-augmented behavioral intervention for trauma-related illness. By providing Dr. Lantrip with mentored research time to conduct this study, this project will help Dr. Lantrip achieve her goal of becoming an independent VA investigator.

创伤后应激障碍（PTSD）在退伍军人中非常普遍。 针对 PTSD 的循证心理治疗 (EBP) 可能有效，但也有局限性 包括高流失率，部分原因是治疗方案冗长，以及持续诊断 尽管完成了基于大脑的替代治疗，仍有大量患者出现创伤后应激障碍（PTSD）。 因此，人们正在探索治疗方法，例如重复经颅磁刺激（rTMS）， rTMS 对治疗抑郁症很有用，并显示出治疗 PTSD 的希望。 向头皮发出磁脉冲，以便通过背外侧安全地调节皮质神经元 前额皮质节点，被认为可以改善认知和情绪标准的控制。 尽管 rTMS 具有增强认知能力的独特特性，但 rTMS 治疗是独立的 添加到 PTSD 的 EBP 中后，控制可能会更有效 PTSD 的简短 EBP 是： 书面暴露疗法（WET）仅需五次疗程即可有效，且损耗有限。 rTMS 与 WET 的整合可以通过改善情绪控制依赖性来提高疗效 认知重构，这被认为是 WET 的作用机制。 可能性尚未测试。 申请人Lantrip博士是一位临床神经心理学家，在大脑行为方面具有专业知识 她在研究行为和神经调节过程方面拥有丰富的经验。 通过博士后研究，她发展了一种理论。 理解导致症状的情绪调节机制的框架 她通过 rTMS 临床试验测试了这一理论。 目前在 VISN 17 回国研究卓越中心担任主要 VA 任命 Lantrip 博士可以接触到大量患有创伤后应激障碍 (PTSD) 的退伍军人以及 此外，Lantrip 博士还与外部建立了合作。 退伍军人 rTMS 治疗和 WET 方面的专家简而言之，Lantrip 博士是其中的专家。 进行必要的研究以增强 PTSD 行为疗法的理想位置 经颅磁刺激。 在拟议的随机对照试验中，Lantrip 博士将比较添加到 WET 的活性 rTMS 在[98]患有 PTSD 的退伍军人中，将假 rTMS 添加到 WET 中，她还将确定 通过确定情绪灵活性是否是治疗的中介因素来确定治疗的作用机制 治疗结果。 总之，该项目将尝试通过添加 rTMS 来增强 WET（针对 PTSD 的简短 EBP）， 它还将尝试确定症状的情绪调节作用机制 如果成功的话，这项工作将影响临床治疗和科学。 该项目对患者和士兵都具有潜在的巨大价值。 在 VA 范围内，为患有 PTSD 的退伍军人提供有效、高效的治疗选择。 治疗还可能有助于跨诊断精神健康障碍的症状改善。 成功完成该项目后，Lantrip 博士将申请 VA 优异评审奖 继续研究 TMS 增强行为干预对创伤相关疾病的影响。 该项目为 Lantrip 博士提供指导研究时间来进行这项研究，该项目将帮助 Lantrip 博士。 Lantrip 实现了成为一名独立的 VA 调查员的目标。