Repetitive Transcranial Magnetic Stimulation Augmented Written Exposure Therapy for Veterans with PTSD

针对患有 PTSD 的退伍军人的重复经颅磁刺激增强书面暴露疗法

• 批准号: 10260136
• 负责人: Crystal Lantrip
• 金额: --
• 依托单位: OLIN TEAGUE VETERANS CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10260136
• 关键词: Affect; Affective; Affective Symptoms; Appointment; Area; Attention; Award; Base of the Brain; Behavior Therapy; Behavioral Mechanisms; Brain; Centers of Research Excellence; Clinic; Clinical; Clinical Treatment; Clinical Trials; Cognition; Cognitive; Collaborations; Diagnosis; Dose; Double-Blind Method; Down-Regulation; Effectiveness; Electromagnetics; Emotional; Emotions; Fellowship; Freedom; Future; Goals; Healthcare; Individual Differences; Intervention; Investigation; Length; Magnetism; Mediating; Mediator of activation protein; Mental Depression; Mental Health; Mental disorders; Mentors; Mission; Neurons; Outcome; Patients; Phase; Physiologic pulse; Positioning Attribute; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Property; Psychotherapy; Quality of Care; Randomized; Randomized Controlled Trials; Research; Research Personnel; Sampling; Scalp structure; Site; Symptoms; Testing; Time; Training; Trauma; Treatment Effectiveness; Treatment Protocols; Treatment outcome; Up-Regulation; Veterans; War; Woman; Work; base; behavioral study; brain behavior; career; cognitive control; cognitive enhancement; effective intervention; effective therapy; emotion dysregulation; emotion regulation; evidence base; experience; flexibility; improved; men; neuromechanism; novel; operation; reduce symptoms; relating to nervous system; repetitive transcranial magnetic stimulation; symptomatic improvement; theories; trauma exposure; treatment effect; treatment-resistant depression

Post-traumatic stress disorder (PTSD) is highly prevalent among post-deployment Veterans. First line evidence-based psychotherapies (EBPs) for PTSD can be effective, but have limitations including high attrition rates, due in part to lengthy treatment protocols, and continued diagnosis of PTSD in a significant number of patients despite treatment completion. Alternate brain-based treatments are thus being explored, like repetitive transcranial magnetic stimulation (rTMS ), which is useful for depression and shows promise for PTSD. rTMS involves applying a repetitive, brief magnetic pulse to the scalp in order to safely modulate cortical neurons via the dorsolateral prefrontal cortex node, which is believed to improve control of cognition and emotions. Standard rTMS treatments are stand-alone, though the unique properties of rTMS enhancing cognitive control may make it more effective when added to an EBP for PTSD. A brief EBP for PTSD that is effective in as few as five sessions with limited attrition is written exposure therapy (WET). Integration of rTMS with WET could improve efficacy by improving emotional control-dependent cognitive restructuring, which is believed to be WET’s mechanism of action. However, this possibility has not been tested. The applicant, Dr. Lantrip, is a clinical neuropsychologist with expertise in brain -behavior relationships. She has significant experience studying behavioral and neural regulatory processes impacting mental health. Through her postdoctoral fellowship, she developed a theoretical framework for understanding the emotion regulatory mechanisms contributing to symptom improvement in rTMS for depression. She tested this theory in an rTMS clinical trial. Through her current primary VA appointment at the VISN 17 Center of Excellence for Research on Returning War Veterans, Dr. Lantrip has access to a large pool of Veterans with PTSD as well as to a research-dedicated TMS machine. Further, Dr. Lantrip has established collaborations with external researchers who are experts in rTMS treatment in Veterans and in WET. In short, Dr. Lantrip is in an ideal position to conduct the necessary research to augment behavioral therapy for PTSD with rTMS. In the proposed randomized controlled trial, Dr. Lantrip will compare active rTMS added to WET with sham rTMS added to WET in [98] Veterans with PTSD. She will also determine the mechanism of action of the treatment by determining if emotional flexibility is a mediator of treatment outcome. In summary, this project will attempt to augment WET, a brief EBP for PTSD, by adding rTMS, and it will also attempt to determine the emotion regulatory mechanism of action for symptom improvement. If successful, this work will influence both clinical treatment and scientific investigation of PTSD. This project will be of potentially great value to both patients and clinicians within the VA by providing an effective, efficient treatment option for veterans with PTSD. This treatment may also facilitate symptom improvement in transdiagnostic mental health disorders. Upon successful completion of this project, Dr. Lantrip will apply for a VA Merit Review Award with continued investigation into TMS-augmented behavioral intervention for trauma-related illness. By providing Dr. Lantrip with mentored research time to conduct this study, this project will help Dr. Lantrip achieve her goal of becoming an independent VA investigator.

创伤后应激障碍（PTSD）在剥离后的退伍军人中非常普遍。第一的 PTSD的线基循证心理治疗（EBP）可以有效，但有局限性 包括高属性率，部分是由于冗长的治疗方案以及继续诊断的 大量患者目的地治疗完成的PTSD。替代大脑 因此，探索了治疗，例如重复的经颅磁刺激（RTMS），这些刺激（RTMS） 对抑郁症有用，并显示出PTSD的希望。 RTMS涉及应用重复的简短 向头皮的磁脉冲，以便通过dor底安全调节皮质神经元 前额叶皮层节点，据信可以改善对认知和情绪的控制。标准 RTMS治疗是独立的，尽管RTM的独特特性增强了认知 当添加到PTSD的EBP中时，控制可能会使它更有效。 PTSD的简短EBP是 在五个属性有限的五个课程中生效是书面暴露疗法（湿）。 RTM与湿的集成可以通过改善情绪控制依赖性提高效率 认知恢复，被认为是湿的作用机理。但是，这个 可能性尚未测试。 申请人Lantrip博士是一名具有脑部专业知识的临床神经心理学家 关系。她有研究行为和神经调节过程的丰富经验 影响心理健康。通过博士后奖学金，她发展了一个理论 理解情绪调节机制有助于症状的框架 抑郁症的RTMS改善。她在RTMS临床试验中测试了这一理论。通过她 VISN 17卓越研究中心的当前主要VA任命 退伍军人，Lantrip博士可以使用PTSD的大量退伍军人，以及 研究专用的TMS机器。此外，Lantrip博士与外部建立了合作 在退伍军人和湿的RTMS治疗方面的专家。简而言之，Lantrip博士在 进行必要研究以增加PTSD行为疗法的理想立场 RTMS。 在拟议的随机对照试验中，Lantrip博士将比较添加到湿的活动RTM 在[98]退伍军人的PTSD退伍军人中添加了假RTMS。她还将确定 通过确定情绪灵活性是否为中介，治疗的作用机理 治疗结果。 总而言之，该项目将通过添加RTMS来尝试增强湿的PTSD的简短EBP， 它还将尝试确定症状的情绪调节作用机制 改进。如果成功，这项工作将影响临床治疗和科学治疗 PTSD的研究。该项目对患者和临床医生都具有巨大的价值 在VA中，通过为具有PTSD的退伍军人提供有效，有效的治疗选择。这 治疗还可能有助于改善转诊性心理健康障碍的症状。 成功完成该项目后，Lantrip博士将申请与 继续投资于与创伤相关的疾病的TMS阐述的行为干预措施。经过 为Lantrip博士提供指导的研究时间来进行这项研究，该项目将帮助博士。 Lantrip实现了成为独立VA调查员的目标。