Neural connectivity before and after each of the three treatment phases of trauma-focused therapy for adolescent posttraumatic stress

青少年创伤后应激障碍创伤聚焦治疗三个治疗阶段前后的神经连接

• 批准号: 10622598
• 负责人: AMY S GARRETT
• 金额: $ 77.51万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10622598
• 关键词: Adolescence; Adolescent; Aftercare; Age; Amygdaloid structure; Anterior; Behavioral; Brain; Brain region; Child; Clinical Trials; Cognitive; Cognitive Therapy; Communities; Consultations; Cues; Data; Development; Dorsal; Early Intervention; Emotional; Functional Magnetic Resonance Imaging; Goals; Impairment; Individual Differences; Investigation; Learning; Left; Link; Long-Term Effects; Methods; Modeling; Neuroanatomy; Neurobiology; Participant; Patients; Pattern; Phase; Population; Post-Traumatic Stress Disorders; Process; Provider; Psychotherapy; Randomized; Randomized, Controlled Trials; Regulation; Research; Scanning; Series; Severities; Sexual abuse; Social Functioning; Structure; Symptoms; Testing; Therapeutic; Trauma; Treatment Protocols; Violence; Youth; abuse victim; biomarker development; boys; brain dysfunction; cognitive function; coping; effective therapy; efficacious treatment; emotional functioning; evidence base; executive function; experience; flexibility; girls; gray matter; habituation; improved; innovation; interpersonal trauma; neural; neurobiological mechanism; neuroimaging; neuromechanism; novel; novel strategies; personalized medicine; physical abuse; post-traumatic stress; recruit; reduce symptoms; response; sex; skill acquisition; skills; social; social skills; symptom treatment; symptomatic improvement; time interval; trauma exposure; treatment as usual; trial design; white matter

PROJECT SUMMARY Posttraumatic stress disorder (PTSD) during adolescence negatively impacts brain networks underlying cognitive, social, and emotional function. Early intervention is important for mitigating long-term effects, but about 20% of youth do not improve sufficiently with current approaches. By identifying the neurobiological mechanisms of effective therapies, we facilitate the development of novel or personalized treatment approaches for youth with PTSD. However, there has been limited progress in identifying the neural mechanisms of treatment using neuroimaging, partly because most studies collect neuroimaging data at only baseline and end-of-treatment, which collapses across multiple parts of the therapeutic process. The objective of the proposed study is to take a new approach by identifying neural mechanisms associated with specific phases of trauma therapy for youth with PTSD. Our central hypothesis is that each phase produces specific brain changes that reflect the acquisition of skills and experiences occurring during that phase. Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) is evidence-based and widely-used to treat children and adolescents with PTSD. It consists of 3 well-defined phases, providing an opportunity to test our hypotheses with neuroimaging: changes in executive control networks will occur during the skills phase, changes in limbic networks during the narrative phase, and changes in default mode networks during the consolidation phase. To test these hypotheses, we will recruit N=180 girls and boys, ages 12-17, who have PTSD following interpersonal trauma, such as physical abuse, sexual abuse, or witnessing violence. We will use a randomized controlled trial design to assign participants to either TF-CBT (provided by study team clinicians who meet fidelity standards and receive consultation from Dr. Judith Cohen, the treatment developer) or Treatment as Usual (TAU; provided in the community and does not follow a phased structure). We will collect functional magnetic resonance imaging (fMRI) data before and after each of the 3 phases of TF-CBT or the same time intervals of TAU. Individual differences in age, sex, dissociative subtype, symptom severity and other variables will be investigated as covariates of phase-related neural changes. Analyses will identify the phases of TF- CBT for which brain regions and networks change for the TF-CBT but not the TAU group. We will also identify the phase(s) that best predict end-of-treatment symptom improvement. Exploratory analyses will use neuroanatomical and white matter diffusivity scans to identify co-occurring changes in brain structure. The proposed innovative study will provide novel information on the neurobiological and cognitive mechanisms associated with the process of trauma therapy for youth with PTSD. 1

项目概要 青春期的创伤后应激障碍 (PTSD) 对潜在的大脑网络产生负面影响 认知、社交和情感功能。早期干预对于减轻长期影响很重要，但是 大约 20% 的青少年在目前的方法下没有取得足够的进步。通过识别神经生物学 有效治疗的机制，我们促进新颖或个性化治疗的开发 患有创伤后应激障碍 (PTSD) 的青少年的方法。然而，在识别神经元方面进展有限。 使用神经影像学的治疗机制，部分原因是大多数研究仅收集神经影像数据 基线和治疗结束，这在治疗过程的多个部分中崩溃。目标 拟议研究的目的是通过识别与特定相关的神经机制来采取新方法 患有 PTSD 的青少年的创伤治疗阶段。我们的中心假设是每个阶段都会产生特定的 反映该阶段发生的技能和经验获取的大脑变化。创伤- 聚焦认知行为疗法 (TF-CBT) 以证据为基础，广泛用于治疗儿童和青少年 患有创伤后应激障碍（PTSD）的青少年。它由 3 个明确定义的阶段组成，为检验我们的假设提供了机会 神经影像学：在技能阶段，执行控制网络会发生变化，边缘系统会发生变化 叙述阶段的网络，以及巩固阶段默认模式网络的变化。 为了检验这些假设，我们将招募 N=180 名 12-17 岁的女孩和男孩，他们患有 PTSD 人际创伤，例如身体虐待、性虐待或目睹暴力。我们将使用随机 对照试验设计将参与者分配到 TF-CBT（由满足以下条件的研究团队临床医生提供） 保真度标准并接受治疗开发者 Judith Cohen 博士的咨询）或治疗 通常（TAU；在社区中提供，不遵循分阶段结构）。我们将收集功能性 TF-CBT 3 个阶段前后或同一时间的磁共振成像 (fMRI) 数据 TAU 的间隔。年龄、性别、分离亚型、症状严重程度和其他变量的个体差异 将作为相位相关神经变化的协变量进行研究。分析将确定 TF- 的阶段 TF-CBT 组的大脑区域和网络发生变化，但 TAU 组的大脑区域和网络没有变化。我们还将确定 最能预测治疗结束症状改善的阶段。探索性分析将使用 神经解剖学和白质扩散扫描，以识别大脑结构中同时发生的变化。这 拟议的创新研究将提供有关神经生物学和认知机制的新信息 与患有 PTSD 的青少年的创伤治疗过程有关。 1