Brain Biomarkers of Clinical Response to Cognitive Treatment of PTSD in Youth

青少年创伤后应激障碍 (PTSD) 认知治疗临床反应的脑生物标志物

• 批准号: 8641725
• 负责人: AMY S GARRETT
• 金额: $ 17.79万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8641725
• 关键词: Adolescence; Adolescent; Adult; Aftercare; Age; Amygdaloid structure; Behavior Therapy; Biological Markers; Brain; Brain region; Child Abuse; Child Abuse and Neglect; Childhood; Chronic; Clinical; Clinical Research; Clinical Trials; Clinical assessments; Cognitive; Cognitive Therapy; Communities; Consultations; DSM-IV; Development; Diagnostic; Disease; Doctor of Medicine; Emotional; Emotions; Ensure; Ethical Issues; Female; Functional Magnetic Resonance Imaging; Future; Goals; Gold; Hippocampus (Brain); K-Series Research Career Programs; Knowledge; Lead; Leadership; Learning; Literature; Longitudinal Studies; Magnetic Resonance Imaging; Maps; Measures; Medial; Mediator of activation protein; Mentors; Methodology; Methods; Modeling; Participant; Patients; Pattern; Population; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Protocols documentation; Recovery; Recruitment Activity; Research Personnel; Research Project Grants; Sampling; Scanning; Schools; Scientist; Series; Severities; Sexual abuse; Site; Stress; Structure; Supervision; Symptoms; Testing; Training; Trauma; Universities; Youth; age group; arm; base; effective therapy; experience; flexibility; knowledge base; meetings; multidisciplinary; neuroimaging; novel; pediatric trauma; physical abuse; public health relevance; relating to nervous system; research study; response; skills; standard care

DESCRIPTION (provided by applicant): This application will combine the neuroimaging expertise of the investigator with new knowledge of clinical trials methodology and treatment processes. The goal is to produce a unique skill set, ideal for leading interdisciplinary teams of clinicians and basic scientists in studies of brain changes associated with treatment of pediatric trauma-related disorders. The proposed research study will apply this training. We will investigate changes in brain function associated with cognitive behavioral therapy for abused youth suffering from PTSD. Each mentor will provide a specific training component needed for the project. Dr. Stewart Agras, an established leader in clinical trials methodology, will provide in-depth knowledge of the intricacies of conducting high quality clinical trials, and a knowledge base of treatment processes. Dr. Victor Carrion, an expert in pediatric PTSD, will provide understanding of assessment, recruitment, and retention of pediatric PTSD samples. Dr. Carrion also will directly oversee the treatment arm of the research study. Dr. Judith Cohen, co-creator of the treatment used in our study (trauma-focused cognitive-behavioral therapy) will provide a practical understanding of treatment: Dr. Garrett will follow each treatment case during Dr. Cohen's weekly consultations with therapists. Dr. Cohen also will provide guidance on important issues in leading clinical research, including collaborating with multidisciplinary partners, ethical issues, and flexible implementation of treatment fidelity. Dr. Kiki Chang has joined the mentoring team in order to provide a model of a successful neuroimaging treatment study exemplified by his ongoing R01 project. Also, Dr. Garrett will learn about clinical assessment by undergoing in Dr. Chang's established protocol for KSADS reliability training, and attending his mentored diagnostic meetings. Dr. Allan Reiss will ensure excellence in neuroimaging analysis and interpretation, Dr. Booil Jo will provide statistical consultation, and Dr. Greg Siegle will provide guidance in leading CBT treatment-related neuroimaging studies based on his leadership in this field. With the assistance of this comprehensive mentoring team, the proposed research project will provide novel information about the mediators (potential mechanisms) of recovery from PTSD and contribute to the literature on abnormal brain function in pediatric PTSD. In the revised application, we have moved the site of the study to Stanford University, to allow mentors to provide direct ongoing clinical research guidance. Youths will be scanned before and after the 12 week treatment. Analyses will identify treatment-related changes in activation in brain regions implicated in PTSD: the amygdala, hippocampus, and medial prefrontal cortex- and test the associations between changes in activation and improvements in symptoms. Test/retest reliability of fMRI measures will be investigated in a matched control sample scanned at the same interval, and functional connectivity will be analyzed. This study is feasible given the considerable expertise in neuroimaging already established by the applicant, the direct supervision of treatment by mentors, and the support provided by Stanford's clinical research setting. This study will establish Dr. Garrett as an independent scientist in the field of neuroimaging treatment studies in youths with PTSD, and lead to an R01 application that expands and probes the clinical utility of the findings.

描述（由申请人提供）：该应用程序将研究者的神经影像学专业知识与临床试验方法和治疗过程的新知识相结合。目标是培养一套独特的技能，非常适合领导由临床医生和基础科学家组成的跨学科团队，研究与儿科创伤相关疾病治疗相关的大脑变化。拟议的研究将应用这种培训。我们将调查患有创伤后应激障碍 (PTSD) 的受虐待青少年与认知行为治疗相关的大脑功能变化。每位导师都会提供项目所需的特定培训内容。 Stewart Agras 博士是临床试验方法领域的知名领导者，他将提供有关进行高质量临床试验的复杂性的深入知识以及治疗过程的知识库。 Victor Carrion 博士是儿科 PTSD 领域的专家，他将提供对儿科 PTSD 样本评估、招募和保留的理解。卡里恩博士还将直接监督该研究的治疗部门。我们研究中使用的治疗方法（以创伤为中心的认知行为疗法）的联合创始人朱迪思·科恩博士（Dr. Judith Cohen）将提供对治疗的实际理解：加勒特博士将在科恩博士每周与治疗师咨询期间跟踪每个治疗案例。科恩博士还将就领先临床研究的重要问题提供指导，包括与多学科合作伙伴的合作、伦理问题以及治疗保真度的灵活实施。 Kiki Chang 博士加入指导团队是为了提供一个成功的神经影像治疗研究模型，他正在进行的 R01 项目就是例证。此外，Garrett 博士还将通过参加 Chang 博士制定的 KSADS 可靠性培训方案并参加他指导的诊断会议来了解临床评估。 Allan Reiss 博士将确保神经影像分析和解释的卓越性，Booil Jo 博士将提供统计咨询，Greg Siegle 博士将基于他在该领域的领导地位，为领先的 CBT 治疗相关神经影像研究提供指导。在这个综合指导团队的协助下，拟议的研究项目将提供有关从 PTSD 中恢复的介质（潜在机制）的新信息，并为儿科 PTSD 脑功能异常的文献做出贡献。在修改后的申请中，我们将研究地点移至斯坦福大学，以便导师能够提供直接的持续临床研究指导。青少年将在 12 周治疗前后接受扫描。分析将确定与 PTSD 相关的大脑区域（杏仁核、海马体和内侧前额皮质）与治疗相关的激活变化，并测试激活变化与症状改善之间的关联。将在以相同间隔扫描的匹配对照样本中研究功能磁共振成像测量的测试/重新测试可靠性，并分析功能连接性。鉴于申请人已经在神经影像学方面建立了相当多的专业知识、导师对治疗的直接监督以及斯坦福大学临床研究机构提供的支持，这项研究是可行的。这项研究将确立 Garrett 博士作为创伤后应激障碍 (PTSD) 青少年神经影像治疗研究领域的独立科学家的地位，并导致 R01 应用扩大和探索研究结果的临床效用。