Treatment of Stress-Related Psychopathology: Targeting Maladaptive and Adaptive Event Processing

压力相关精神病理学的治疗：针对适应不良和适应性事件处理

• 批准号: 10188644
• 负责人: NORAH C FEENY
• 金额: $ 54.01万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10188644
• 关键词: Adherence; Affect; Chard; Clinical; Disease; Distress; Dose; Dropout; Economic Burden; Educational process of instructing; Emotional; Emotions; Environment; Etiology; Event; Exposure to; Feedback; Future; Health; Human; Impairment; Individual; Intervention; Job loss; Left; Life; Link; Measures; Mental Depression; Minority; Modeling; Muscle relaxation phase; National Institute of Mental Health; Negative Valence; Outcome; Pathologic; Patients; Population; Positive Valence; Post-Traumatic Stress Disorders; Prevalence; Process; Prospective Studies; Psychopathology; Psychotherapy; Randomized; Relapse; Research; Rewards; Risk; Role; Sampling; Strategic Planning; Stress; Stressful Event; Symptoms; System; Taxes; Therapeutic; Time; Update; Work; burden of illness; control trial; coping; cost; depressive symptoms; disabling symptom; evidence base; experience; experimental study; follow-up; improved; innovation; loved ones; negative mood; novel; positive emotional state; prevent; psychologic; randomized trial; relapse risk; resilience; reward processing; sexual assault; skills; stressor; therapeutic target; Adherence; Affect; Chard; Clinical; Disease; Distress; Dose; Dropout; Economic Burden; Educational process of instructing; Emotional; Emotions; Environment; Etiology; Event; Exposure to; Feedback; Future; Health; Human; Impairment; Individual; Intervention; Job loss; Left; Life; Link; Measures; Mental Depression; Minority; Modeling; Muscle relaxation phase; National Institute of Mental Health; Negative Valence; Outcome; Pathologic; Patients; Population; Positive Valence; Post-Traumatic Stress Disorders; Prevalence; Process; Prospective Studies; Psychopathology; Psychotherapy; Randomized; Relapse; Research; Rewards; Risk; Role; Sampling; Strategic Planning; Stress; Stressful Event; Symptoms; System; Taxes; Therapeutic; Time; Update; Work; burden of illness; control trial; coping; cost; depressive symptoms; disabling symptom; evidence base; experience; experimental study; follow-up; improved; innovation; loved ones; negative mood; novel; positive emotional state; prevent; psychologic; randomized trial; relapse risk; resilience; reward processing; sexual assault; skills; stressor; therapeutic target

PROJECT SUMMARY Evidence-based psychotherapies for posttraumatic stress disorder (PTSD) and depression consistently produce strong, clinically meaningful effects for many individuals. However, these interventions also have significant dropout rates, a large minority of individuals continue to have debilitating symptoms, and even those who respond may be vulnerable to relapse upon future stressors. More efficient and mechanistically precise interventions are needed. Consistent with the cross-cutting theme of studying the role of the environment in the NIMH Strategic Plan, the etiologic role of exposure to destabilizing, stressful life events is common to both PTSD and depression. Not only do they share common distress-related triggers, symptoms, and maintaining processes, but they also commonly co-occur (upwards of 60%). Current PTSD and depression treatments typically focus on their respective disorders rather than on common processes that maintain psychopathology; and, importantly, they do not explicitly target positive adaptive processes associated with resilience. Decades of experimental studies, prospective studies, and psychotherapy trials have identified interconnected maladaptive and adaptive processes associated with persistent psychopathology after stressful, destabilizing events. These maladaptive processes include: 1) unproductive event processing; 2) avoidance; and 3) reward sensitivity and processing deficits. These processes prolong negative mood, interfere with adaptive coping and processing of emotional material, and increase sensitivity to future stressful life events. PATH (Positive Processes and Transition to Health) directly targets these maladaptive processes while also teaching parallel adaptive skills (constructive processing, approach, and positive emotion processing and reward seeking). Six, 90-min sessions target individuals who have experienced a destabilizing life event and have persistent stressor-related symptoms. PATH utilizes life event processing (revisiting, meaning making), focusing repeatedly on an identified destabilizing life event, positive life events, and future events as a framework to identify maladaptive processes and teach constructive processing skills. In a small open trial (R61, N = 45), we will examine whether PATH engages the key targets of unproductive processing, avoidance, and reward deficits. Next, we will conduct a randomized trial of PATH (R33, N = 135), comparing PATH to a Progressive Muscle Relaxation, seeking to replicate changes in the targets in a larger sample and examine PATH's impact on stressor-related psychopathology (PTSD, depression). PATH, a brief and focused treatment that targets key psychological processes common to PTSD and MDD, has the potential to reduce dropout, improve treatment engagement and outcomes, identify potential treatment mechanisms, and ultimately reduce the costly human and economic burden of stressor-related psychopathology.

项目摘要 创伤后应激障碍（PTSD）和抑郁症的循证心理治疗 为许多人产生强大的临床意义。但是，这些干预措施也有 大量的辍学率，很大的个体继续具有使人衰弱的症状，甚至是 反应的人可能很容易对未来的压力源复发。更有效，机械精确 需要干预。与研究环境在 NIMH战略计划，暴露于破坏稳定的，压力大的生活事件的病因学作用是两者共同的 PTSD和抑郁症。它们不仅具有共同的与遇险相关的触发器，症状和维持 过程，但它们通常也同时发生（超过60％）。当前的PTSD和抑郁疗法 通常关注他们各自的疾病，而不是保持心理病理学的共同过程。 而且，重要的是，它们没有明确针对与弹性相关的积极适应过程。几十年 实验研究，前瞻性研究和心理治疗试验已经确定了相互联系 压力不稳定，不良心理病理学相关的适应性和适应性过程 事件。这些不良适应性过程包括：1）非生产性事件处理； 2）避免； 3）奖励 灵敏度和处理缺陷。这些过程延长了负面情绪，干扰了自适应应对和 处理情绪材料，并提高对未来压力性生活事件的敏感性。路径（正 过程和向健康的过渡）直接针对这些不良适应过程，同时教导平行教学 自适应技能（建设性的处理，方法和积极的情绪处理和寻求奖励）。六， 90分钟的会议目标是经历过稳定生活事件并持续存在的个人 与压力源相关的症状。路径利用生活事件处理（重新审视，含义制作），专注于 反复在确定的破坏稳定的生活事件，积极的生活事件和未来事件作为框架 确定适应不良的过程并教授建设性的处理能力。在一次小型开放试验中（R61，n = 45），我们 将检查路径是否参与非生产性处理，回避和奖励的关键目标 缺陷。接下来，我们将进行路径的随机试验（R33，n = 135），将路径与渐进性进行比较 肌肉放松，试图复制较大样本中目标的变化并检查路径的影响 关于与压力源相关的心理病理学（PTSD，抑郁症）。路径，一种针对关键的简短而重点的治疗 PTSD和MDD常见的心理过程有可能减少辍学，改善治疗 参与和结果，确定潜在的治疗机制，并最终减少昂贵的人类 和与压力源相关的心理病理学的经济负担。