Project IMPACT: In-the-Moment Protection from Automatic Capture by Triggers

项目影响：通过触发器自动捕获的即时保护

• 批准号: 9203038
• 负责人: MARSHA E. BATES
• 金额: $ 53.8万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-20 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9203038
• 关键词: Abstinence; Address; Affect; Affective; Aftercare; Alcohol consumption; Alcohols; Anxiety; Arousal; Attention; Baroreflex; Behavior Control; Behavior Therapy; Behavioral; Behavioral Mechanisms; Biofeedback; Biological; Biological Process; Blood Vessels; Brain; Breathing; Cardiac; Cellular Phone; Child; Client; Clinical Research; Cognitive; Communication; Communities; Computer Simulation; Conscious; Cues; Data; Desire for food; Disease; Drug usage; Electrocardiogram; Emotions; Functional Magnetic Resonance Imaging; Generations; Genetic; Goals; Health; Heart; Individual; Intervention; Knowledge; Laboratories; Lead; Life; Link; Mediating; Mental Depression; Modeling; Mothers; Myocardium; Neurobiology; Outcome; Outpatients; Participant; Pattern; Persons; Pharmaceutical Preparations; Physiological; Physiology; Placebos; Population; Process; Public Health; Randomized; Randomized Clinical Trials; Reaction; Recovery; Relapse; Research; Research Support; Role; Sampling; Signal Transduction; Specific qualifier value; Stress; System; Techniques; Testing; Time; Training; Translating; Translational Research; Trauma; Treatment outcome; Visceral; Woman; addiction; alcohol abuse therapy; alcohol and other drug; alcohol use disorder; base; behavior change; biobehavior; biological systems; cognitive control; cognitive enhancement; cognitive function; craving; drinking; drinking behavior; emotion regulation; experimental study; flexibility; heart rate variability; improved; negative affect; novel strategies; operation; person centered; post intervention; predictive modeling; public health relevance; relating to nervous system; response; therapy design; treatment as usual; treatment program

DESCRIPTION (provided by applicant): There are effective behavioral interventions to treat alcohol use disorders, but over time, treatment gains are often lost when clients find themselves unable to resist drinking because of negative emotions and appetitive cues. The power of internal and environmental "triggers" to elicit relapse, even among clients with conscious abstinence goals and extended abstinence, is compelling and well-documented. Thus, bolstering clients' ability to withstand drinking triggers and craving in real time could have tremendous public health impact. This application proposes translational research that focuses on the a priori defined and malleable baroreflex (BAR) mechanism. The BAR is a dynamic mechanism that helps to regulate automatic-visceral reactivity to triggers of alcohol and other drug use by regulating bidirectional communication between the heart and brain. A key feature of the BAR mechanism is that it can be consciously manipulated using a simple behavioral breathing technique called resonance breathing. This manipulation can occur "in the moment" and outside of the treatment context as triggers are anticipated or encountered. This application proposes a randomized clinical trial of a BAR-based intervention (added to behavioral treatment as usual) in conjunction with laboratory assessments (pre-post intervention design), and computational modeling to validate the operation of the BAR as a biobehavioral change mechanism. The sample comprises women with young children from an empirically supported, intensive outpatient behavioral treatment program (IOP). The intervention involves daily use of iPhone applications (apps) during IOP treatment weeks 4-12. Those randomized to the active intervention will be trained to use an existing resonance breathing app to activate the BAR mechanism as they anticipate or confront emotions or cues that can trigger relapse. Participants in the placebo group will use an app that does not affect the BAR. Aim 1 will address whether activating the BAR mechanism accelerates and stabilizes positive behavior change, specifically change in alcohol and drug use, anxiety, craving, depression during and after treatment. Aim 2 will compare natural versus manipulated changes in BAR functioning pre- to post- intervention using physiological, and, for a subset of women, fMRI data to correlate biological and behavioral change. Aim 3 will characterize how and for whom the BAR mechanism supports behavior change using computational modeling to capture change across multiple interacting biological systems within a person. The novelty of this study comes from focusing on a well-specified automatic-physiological mechanism, capturing change in the dynamic space of "real life" replete with triggers and affective changes, characterizing the BAR mechanism across biobehavioral levels using variable-and person-centered quantitative strategies, and focusing on an understudied population whose positive behavior change can have important immediate and long-term health implications. If successful, the proposed research will set the stage for a new generation of mechanism-based intervention approaches and personalized prognostic models.

描述（由申请人提供）：有有效的行为干预措施来治疗酒精使用障碍，但随着时间的推移，当客户发现自己由于负面情绪和食欲暗示而无法抗拒饮酒时，治疗效果往往会丧失。即使在有自觉禁欲目标和长期禁欲的客户中，内部和环境“触发”引起复发的力量也是令人信服且有据可查的。因此，增强客户实时抵御饮酒触发因素和渴望的能力可能会对公共健康产生巨大影响。该申请提出了重点关注先验定义的可延展性压力反射（BAR）机制的转化研究。 BAR 是一种动态机制，通过调节心脏和大脑之间的双向通讯，有助于调节对酒精和其他药物使用触发因素的自动内脏反应。 BAR 机制的一个关键特征是，可以使用称为共振呼吸的简单行为呼吸技术来有意识地操纵它。当预期或遇到触发因素时，这种操纵可以发生在“当下”并且在治疗环境之外。该申请提出了一项基于 BAR 的干预措施（照常添加到行为治疗中）的随机临床试验，结合实验室评估（干预前设计）和计算模型来验证 BAR 作为生物行为改变机制的运作。样本包括来自经验支持的强化门诊行为治疗计划 (IOP) 的有幼儿的女性。干预措施包括在 IOP 治疗第 4-12 周期间每天使用 iPhone 应用程序 (apps)。那些随机接受主动干预的人将接受培训，在他们预期或面对可能引发复发的情绪或线索时，使用现有的共振呼吸应用程序来激活 BAR 机制。安慰剂组的参与者将使用不影响 BAR 的应用程序。目标 1 将解决激活 BAR 机制是否会加速和稳定积极的行为改变，特别是治疗期间和治疗后酒精和药物使用、焦虑、渴望、抑郁的改变。目标 2 将使用生理学和功能磁共振成像数据来比较干预前后 BAR 功能的自然变化和人为变化，以将生物学和行为变化关联起来。目标 3 将描述 BAR 机制如何以及为谁支持行为改变，使用计算模型捕获人体内多个相互作用的生物系统的变化。这项研究的新颖之处在于关注明确的自动生理机制，捕捉充满触发因素和情感变化的“现实生活”动态空间中的变化，使用变量和以人为中心来描述跨生物行为层面的 BAR 机制。定量策略，并关注未充分研究的人群，他们的积极行为改变可能对健康产生重要的短期和长期影响。如果成功，拟议的研究将为新一代基于机制的干预方法和个性化预后模型奠定基础。