A Randomized Controlled Trial of Cognitive Control Training for Urgency in a Naturalistic Clinical Setting

自然临床环境中紧急认知控制训练的随机对照试验

• 批准号: 9463259
• 负责人: Andrew D Peckham
• 金额: $ 5.63万
• 依托单位: MCLEAN HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9463259
• 关键词: Acute; Address; Adult; Alcohol or Other Drugs use; Anterior; Auditory; Behavior; Behavioral; Binge Eating; Biological; Brain; Brain region; Clinical; Cognitive; Cognitive deficits; Conflict (Psychology); Control Groups; Day Care; Detection; Dimensions; Disease; Educational Intervention; Electrophysiology (science); Emotions; Enrollment; Evaluation; Event-Related Potentials; Exercise; Goals; Impulsivity; Individual; Intervention; Link; Measures; Mental Depression; Mental Health; Mental disorders; Mentors; Mentorship; Meta-Analysis; Methodology; Mind; National Institute of Mental Health; Outcome; Participant; Patient Self-Report; Patients; Prefrontal Cortex; Preparation; Protocols documentation; Psychopathology; Randomized; Randomized Controlled Trials; Recruitment Activity; Reflex action; Reporting; Research; Sampling; Self-Injurious Behavior; Short-Term Memory; Signal Transduction; Step Tests; Suicide; Suicide attempt; Surveys; Symptoms; Techniques; Testing; Time; Training; Training Programs; Translating; Translations; Work; acute symptom; base; behavior measurement; behavior test; behavioral response; cingulate cortex; cognitive control; cognitive training; computerized; craving; density; emotion dysregulation; experience; injured; negative affect; novel strategies; programs; prospective; reduce symptoms; relating to nervous system; response; satisfaction; severe mental illness; source localization; successful intervention; trait; treatment as usual; treatment program; treatment response

Project Summary/Abstract Impulsivity is a common and significant predictor of destructive, maladaptive behaviors among people with mental illness. Research shows that one specific type of impulsivity, known as urgency, is particularly problematic. This type of impulsivity refers to reflexive responses to strong emotions. As emotion dysregulation is a well-established transdiagnostic feature of mental illness, the construct of urgency represents a “perfect storm” of both reactivity to emotion and impulsive action. Elevations in this form of impulsivity predict serious negative outcomes including self-injury, suicide attempts, and poor response to treatment. Despite these dire consequences, there are no specific, targeted treatments for urgency. However, the mechanisms that might influence the expression of this trait are beginning to be understood. Urgency is related to several cognitive deficits, including difficulty stopping a planned behavior (response inhibition) as well as difficulty storing and manipulating information in mind for short periods of time (working memory). Recent findings suggest that people who completed computerized exercises involving response inhibition and working memory showed significantly reduced levels of urgency after two weeks of treatment. However, it is unknown if this improvement would be observable among individuals with serious mental illness, or whether this type of training actually produces changes in the putative underlying brain regions that support response inhibition and working memory. In this study, we will recruit adult patients reporting high levels of urgency who are receiving treatment for acute symptoms of mental illness in an intensive Partial Hospitalization Program. Patients will be randomly assigned to receive treatment as usual (TAU) or to receive TAU augmented with a two-week computerized cognitive training program targeting response inhibition and working memory. All participants will undergo electrophysiological recording of brain activity (EEG) at baseline and upon discharge from the program, in order to test changes in brain activity relevant to response inhibition and working memory. The goals of this project are to (1) confirm that the cognitive training intervention successfully engages underlying brain mechanisms; (2) test whether this training is associated with greater clinical improvements in depression, urges to self-injure, or urges to use substances; and (3) assess feasibility and acceptability to patients using this intervention in a naturalistic setting. If successful, this study may provide evidence that this new approach to treating impulsivity effectively engages underlying biological mechanisms, is clinically efficacious, and is applicable to real-world clinical settings. These goals are highly consistent with the NIMH's Third Strategic Aim, which states that “The challenge is to test…potential mechanisms rapidly to rule in or rule out the target as a mechanism of the illness. This requires that the intervention engage the target and test its efficacy for reducing symptoms.” The present study embraces this challenge to rapidly test a treatment targeting cognitive mechanism underlying a trait with serious consequences for mental health.

项目概要/摘要 冲动是患有这种疾病的人中破坏性、适应不良行为的常见且重要的预测因素。 研究表明，一种特定类型的冲动（称为紧迫感）尤其严重。 这种类型的冲动是指对强烈情绪的反射性反应。 是精神疾病的一个公认的跨诊断特征，紧迫性的构建代表了“完美的” 对情绪的反应和冲动行为的“风暴”，这种形式的冲动预示着严重的后果。 负面结果包括自残、自杀企图和治疗反应不佳，尽管这些情况很可怕。 目前尚无针对紧急情况的具体、有针对性的治疗方法，但可能存在机制。 人们开始理解，紧迫性与多种认知有关。 缺陷，包括难以停止计划的行为（反应抑制）以及难以存储和 最近的研究结果表明，在短时间内操纵大脑中的信息（工作记忆）。 完成涉及反应抑制和工作记忆的计算机化练习的人显示 经过两周的治疗后，紧迫感显着降低，但尚不清楚是否会出现这种情况。 在患有严重精神疾病的人中可以观察到改善，或者这种类型的 训练实际上会导致假定的潜在大脑区域发生变化，这些区域支持反应抑制和 在这项研究中，我们将招募正在接受治疗的报告高度紧急的成年患者。 患者将接受强化部分住院治疗计划中的精神疾病急性症状的治疗。 随机分配接受照常治疗 (TAU) 或接受两周 TAU 强化治疗 针对反应抑制和工作记忆的计算机化认知训练计划。 在基线和放电时对大脑活动（EEG）进行电生理记录 程序，以测试与反应抑制和工作记忆相关的大脑活动的变化。 该项目的目标是（1）确认认知训练干预成功地参与了潜在的 大脑机制；（2）测试这种训练是否与抑郁症的临床改善有关， 冲动自残或冲动使用物质；以及 (3) 评估患者使用药物的可行性和可接受性； 如果这种在自然主义环境下的干预成功的话，这项研究可能会为这种新方法提供证据。 有效治疗冲动涉及潜在的生物机制，在临床上有效，并且 适用于现实世界的临床环境，这些目标与 NIMH 的第三个战略目标高度一致。 其中指出，“挑战是测试……快速确定或排除目标的潜在机制” 这需要干预措施针对目标并测试其减少疾病的功效。 目前的研究接受了这一挑战，以快速测试针对认知的治疗方法。 对心理健康产生严重后果的特征背后的机制。