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）：虽然尚无可卡因依赖性FDA批准的药物，但行为疗法（例如认知行为疗法（CBT））具有强大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疗法机制的有前途的策略，以及确定潜在的新型治疗靶标。我们建议将三个成像会（预处理，治疗后和6个月的随访）添加到最近开始的随机临床试验中，评估了从父母试验中获得的两种形式的CBT（治疗师和计算机提供的治疗师（治疗师和计算机）的标准咨询）。使用提出的任务（Stroop颜色的干扰和货币激励延迟任务）和措施（白质完整性，区域大脑体积和静止状态脑功能）使用源自初步数据的假设，我们将：1）研究：1）研究成像任务基础测量的程度； 2）评估从治疗前到治疗后（基线到12周）和按治疗条件（CBT与标准咨询与标准咨询）的fMRI措施的变化； 3）检查脑部激活内部治疗变化与6个月的随访结果的关系（重点是了解CBT的耐用性和“卧铺”效应）； 4）研究大脑激活与CBT“剂量”之间的关系（CBT会话和完成作业）。该项目利用了一个难得的机会来评估与成瘾治疗尤其是成瘾治疗相关的神经作用机制，以及一个独特的机会来检查与CBT效果持续性（“卧铺”效应）相关的神经因素。证明与CBT相关的认知控制改善的大脑激活变化的持久变化将代表阐​​明和增强治疗效果的重要一步，并了解CBT的作用机制，使临床医生能够将特定技能和策略靶向最有可能从中受益的个人。