Neural mechanisms of CBT in cocaine dependence

可卡因依赖中 CBT 的神经机制

• 批准号: 8914560
• 负责人: KATHLEEN M. CARROLL
• 金额: $ 64.13万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8914560
• 关键词: Abstinence; Aftercare; Amygdaloid structure; Anterior; Behavior Therapy; Brain; CD7 gene; Clinical; Clinical Trials; Cocaine; Cocaine Dependence; Cognitive Therapy; Color; Computers; Corpus striatum structure; Counseling; Data; Dorsal; Dose; Effectiveness; Evaluation; FDA approved; Functional Magnetic Resonance Imaging; Funding; Goals; Health; Hippocampus (Brain); Image; Incentives; Individual; Inferior frontal gyrus; Insula of Reil; Magnetic Resonance Imaging; Manuals; Measures; Medial; Mediating; Mediator of activation protein; Modeling; Neurobiology; Notification; Outcome; Parents; Performance; Pharmaceutical Preparations; Prefrontal Cortex; Process; Randomized; Randomized Clinical Trials; Relative (related person); Rest; Rewards; Time; Treatment outcome; Ventral Striatum; addiction; base; brain volume; cingulate cortex; cocaine use; cognitive control; comparative efficacy; follow-up; improved; innovation; insight; neuroimaging; neuromechanism; non-drug; novel; relating to nervous system; reward processing; skill acquisition; skills; therapy development; treatment as usual; treatment effect; treatment response; trial comparing; white matter

DESCRIPTION (provided by applicant): While there are as of yet no FDA-approved medications for cocaine dependence, behavioral therapies such as cognitive-behavioral therapy (CBT) have strong empirical support as well as durability of effects. Evaluation of neurobiological factors is a promising strategy for evaluating mechanisms of empirically supported therapies, as well as for identifying potentially novel targets for treatment development. We propose to add three imaging sessions (pre-treatment, post-treatment, and 6-month follow-up) to a recently initiated randomized clinical trial evaluating two forms of CBT (therapist- and computer-delivered) versus manual-guided standard counseling for 96 cocaine-dependent individuals drawn from the parent trial. Using hypotheses derived from preliminary data using the proposed tasks (Stroop Color-Word Interference and Monetary Incentive Delay Tasks) and measures (white matter integrity, regional brain volumes and resting state brain function), we will: 1) investigate the extent to which the baseline measures of the imaging tasks predict treatment outcomes; 2) evaluate changes in fMRI measures from pre- to post-treatment (baseline to 12 weeks) and by treatment condition (CBT versus standard counseling); 3) examine the relationship of within- treatment change in brain activation to 6-month follow-up outcomes (with an emphasis on understanding CBT's durability and "sleeper" effect); and 4) investigate the relationships between brain activations and CBT "dosing" (CBT sessions and homework completed). This project leverages a rare opportunity to evaluate neural mechanisms of action associated with addiction treatment in general and CBT in particular, as well as a unique opportunity to examining neural factors related to the durability of effects ("sleeper" effects) in CBT. Demonstration of durable changes in brain activation paralleling CBT-related improvements in cognitive control would represent an important step in elucidating and strengthening treatment effects, as well as understanding CBT's mechanisms of action, enabling clinicians to target specific skills and strategies to the individuals most likely to beneit from them.

描述（由申请人提供）：虽然目前还没有 FDA 批准的治疗可卡因依赖的药物，但认知行为疗法 (CBT) 等行为疗法具有强有力的经验支持以及效果的持久性。神经生物学因素的评估是评估经验支持的治疗机制以及确定治疗开发的潜在新靶点的一种有前途的策略。我们建议在最近启动的一项随机临床试验中添加三个成像疗程（治疗前、治疗后和 6 个月随访），该试验评估两种形式的 CBT（治疗师和计算机提供）与人工指导的标准咨询针对来自母公司试验的 96 名可卡因依赖者。使用从初步数据中得出的假设，使用所提出的任务（斯特鲁普色词干扰和货币激励延迟任务）和测量（白质完整性、区域脑容量和静息状态脑功能），我们将：1）调查成像任务的基线测量可预测治疗结果； 2）评估从治疗前到治疗后（基线至12周）和治疗条件（CBT与标准咨询）fMRI测量值的变化； 3) 检查治疗内大脑激活变化与 6 个月随访结果的关系（重点是了解 CBT 的持久性和“睡眠”效应）； 4) 研究大脑激活和 CBT“剂量”（CBT 课程和完成的作业）之间的关系。该项目利用了一个难得的机会来评估与一般成瘾治疗（特别是 CBT）相关的神经作用机制，以及一个独特的机会来检查与 CBT 效果（“睡眠”效果）持久性相关的神经因素。证明大脑激活的持久变化与 CBT 相关的认知控制改善相平行，将代表着阐明和加强治疗效果以及理解 CBT 作用机制的重要一步，使临床医生能够针对最有可能出现这种情况的个体制定特定的技能和策略。从他们那里受益。