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: 9906153
• 负责人: Eric D Claus
• 金额: $ 61.33万
• 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 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906153
• 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：尽管存在适度有效的酒精使用障碍治疗方法（AUD），但许多人 完成治疗后，复发到大量饮酒，表明需要更好地了解 导致成功结果的因素。而过去的研究中的大部分重点一直在 确定哪些治疗方法对auds起作用，直到最近才关注特定治疗 工作以及治疗导致饮酒变化的机制。关注机制 行为改变（MOBC）不仅有可能累积有关该知识的知识 治疗导致更好结果的过程，但也可能导致新治疗的发展 或对靶向凭经验支持的机制的现有治疗方法的修改 改变。现有的研究集中在潜在机制上，包括酒精提示反应性，影响 调节和行为控制，但是这些结构已在很大程度上使用自我报告措施进行了测试， 从神经认知的角度来看，研究这些机制存在明显的研究。 为了解决知识的这一差距，拟议的研究将在多个层面上检查MOBC，包括自我 报告，行为表现和神经网络参与，重点是侧面的功能 内侧额叶控制网络，基于纹状体的奖励网络和情感上的杏仁核网络 反应性。一百八十个寻求治疗的人将随机分配 接受4周认知行为治疗（CBT）或基于正念的治疗（MBT）4周后 几周的平台处理，重点是增强变革的动力。建立时间 饮酒变化与这些MOBC的变化之间的关系，将评估患者：（a） 基线； （b）治疗四个星期； （c）立即治疗； （d）9月和15个月后 基线。自我报告措施和行为任务将在治疗期间每月每月进行； fMRI将在基线和基线后3和9个月收集。变化之间的关系 在饮酒和拟议的MOBC的变化中，将使用先进的混合建模技术检查 由研究团队开创的。此外，该项目将利用在单独的 在非治疗中检查MOBC的项目，以相似的相同措施寻求样本 时间点。通过识别CBT或MBT的MOBC，这些MBT有差异地导致饮酒的变化， 拟议的项目不仅将对成功的行为改变有更深入的了解，而且还可以 告知开发AUD的新型治疗方法。另外，通过识别神经认知因素 可以预测成功变化，可能可以利用这些知识将特定疗法与 特定的患者神经认知特征。