Neural Mechanisms of a Novel Psychotherapy in Veterans with PTSD and Alcoholism

患有创伤后应激障碍和酗酒的退伍军人的新型心理治疗的神经机制

• 批准号: 8539972
• 负责人: ANDREA SPADONI TOWNSEND
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8539972
• 关键词: Affect; Affective; Afghanistan; Aftercare; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcoholism; Alcohols; Amygdaloid structure; Anterior; Biological Neural Networks; Brain; Caring; Clinical Practice Guideline; Clinical Trials Design; Cognitive Therapy; Comorbidity; Coping Skills; Corpus striatum structure; Cues; Development; Diagnosis; Disease; Disease remission; Drug Addiction; Drug abuse; Effectiveness; Etiology; Exposure to; Functional Magnetic Resonance Imaging; Funding; Goals; Healed; Image; Incentives; Incidence; Individual; Insula of Reil; Intervention; Intervention Studies; Iraq; Knowledge; Legal; Link; Maintenance; Measures; Medical; Mental disorders; Mission; Neurobiology; Nucleic Acid Regulatory Sequences; Outcome; Participant; Pathogenesis; Patients; Pattern; Play; Population; Post-Traumatic Stress Disorders; Prefrontal Cortex; Psychotherapy; Randomized Controlled Trials; Relative (related person); Research; Rewards; Role; Safety; Services; Severities; Social Problems; Stress; Structure; Substance Use Disorder; Symptoms; Therapeutic; Treatment Efficacy; Treatment outcome; Veterans; Visual; alcohol cue; alcohol use disorder; alternative treatment; base; blood oxygen level dependent; clinical practice; combat; compare effectiveness; cue reactivity; drinking; effective therapy; evidence base; functional outcomes; healing; improved; member; neural circuit; neurobiological mechanism; neuroimaging; neuromechanism; neuropsychiatry; novel; psychologic; psychological outcomes; public health relevance; relating to nervous system; response; tool; treatment effect; treatment response; treatment strategy; trial comparing

DESCRIPTION (provided by applicant): Rates of posttraumatic stress disorder (PTSD) are high among combat Veterans. Estimates of PTSD within Iraq and Afghanistan Veterans suggest that nearly 17% of active duty and over 24% of reserve service members screen positive for PTSD. Among individuals diagnosed with PTSD, the incidence of drug abuse and addiction is markedly elevated, with the highest comorbidity observed for alcohol use disorders, estimated to be as high as 85% in individuals seeking PTSD treatment. When these comorbidities manifest they result in poorer psychological, functional, and treatment outcomes than either disorder alone. Evidence suggests that neurobiological mechanisms, such as dysregulation of specific brain structures (e.g., amygdala, insula, prefrontal cortex, and striatum) appear to play crucial roles in the maintenance and remission of concurrent AD/PTSD. Currently there are no translational imaging studies that have examined whether patterns of brain activation can predict differences in treatment response in this population, and no attempts have been made to link psychotherapeutic interventions to neurobiological targets in AD/PTSD individuals. Therefore, the long- term goal of this line of research is to use neuroimaging tools to advance our ability to provide optimized, targeted interventions that support improved outcomes for Veterans with AD/PTSD. The objective of this proposal, which is a first step in pursuit of this goal, is to measure the brain response to an anticipatory task and an alcohol cue reactivity task before and after treatment for AD/PTSD in order to 1) delineate a neural profile of treatment responsiveness to empirically supported interventions, and 2) to compare the relative effects of an exposure based to a non-exposure based treatment on the neural substrates thought to maintain these disorders. Participants will receive one of two, 8-week-long, treatments within an ongoing, VA-funded, randomized controlled trial designed to compare the effectiveness of an exposure-based psychotherapy (i.e., Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE)) against the widely used psychotherapy, Seeking Safety (SS), that does not include exposure for the treatment of AD/PTSD. We hypothesize that baseline patterns of brain response will relate to the capacity to improve in the context of therapy, and that the sub-components of COPE and SS will differentially affect change in those neural circuits maintaining AD/PTSD.

描述（由申请人提供）： 在战斗退伍军人中，创伤后应激障碍（PTSD）的发生率很高。伊拉克和阿富汗退伍军人内PTSD的估计表明，近17％的现役和24％的储备服务员筛选为PTSD。在被诊断为PTSD的个体中，药物滥用和成瘾的发病率显着升高，在寻求PTSD治疗的人中，饮酒障碍的合并症最高，据估计高达85％。当这些合并症表现出来时，它们会导致心理，功能和治疗结果较差，而不是任何一种疾病。有证据表明，神经生物学机制，例如特定大脑结构（例如杏仁核，岛菌，前额叶皮层和纹状体）的失调似乎在维持和缓解同意AD/PTSD中起着至关重要的作用。 当前，尚无转化成像研究研究，还研究了大脑激活模式是否可以预测该人群的治疗反应差异，并且没有尝试将心理治疗干预措施与AD/PTSD个体中的神经生物学靶点联系起来。因此，这一研究的长期目标是使用神经影像学工具来提高我们的能力 提供优化的，有针对性的干预措施，以支持AD/PTSD的退伍军人改善结果。 The objective of this proposal, which is a first step in pursuit of this goal, is to measure the brain response to an anticipatory task and an alcohol cue reactivity task before and after treatment for AD/PTSD in order to 1) delineate a neural profile of treatment responsiveness to empirically supported interventions, and 2) to compare the relative effects of an exposure based to a non-exposure based treatment on the neural substrates thought to maintain these disorders.参与者将在持续的，VA资助的随机对照试验中获得两次，为期8周的治疗方法之一，旨在比较基于暴露的心理治疗的有效性（即，对PTSD的同时治疗PTSD和使用长期暴露（COPE）的物质使用障碍（COPE）），以与广泛使用的心理疗法相比，该治疗方法不包括安全性（包括安全性），包括PET（SSS）。我们假设大脑反应的基线模式将与治疗背景下改善的能力有关，并且COPE和SS的子组件将在维持AD/PTSD的那些神经回路的变化中有所不同。