A Virtual World/Neurofeedback Real Time Functional MRI Approach to PTSD Treatment

虚拟世界/神经反馈实时功能 MRI 治疗 PTSD 的方法

• 批准号: 10174842
• 负责人: RAMIRO SALAS
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2020-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10174842
• 关键词: Automobile Driving; Awareness; Biofeedback; Brain; Brain imaging; Breathing; Computer Models; Conscious; Costs and Benefits; Custom; Data; Devices; Electroencephalography; Environment; Explosion; Exposure to; Family; Feedback; Functional Magnetic Resonance Imaging; Future; Heart Rate; Heterogeneity; Hybrids; Individual; Intervention; Iraq; Learning; Life; Link; Machine Learning; Magnetic Resonance Imaging; Maps; Measurement; Measures; Memory; Methods; Modeling; Monitor; Participant; Patient Recruitments; Patient Self-Report; Patients; Physical activity; Physiological; Physiology; Pilot Projects; Post-Traumatic Stress Disorders; Process; Psyche structure; Psychiatry; Reporting; Side; Signal Transduction; Stimulus; Stress; Symptoms; System; Techniques; Technology; Therapeutic; Therapeutic Effect; Thinking; Time; Training; Veterans; Visit; War; Work; Wrist; base; combat; coping; experience; experimental study; heart rate monitor; improved; innovation; insight; machine learning algorithm; neurofeedback; novel; novel strategies; relating to nervous system; response; sleep pattern; sleep quality; stress state; stressor; success; time use; tool; trauma exposure; virtual; virtual reality; virtual reality environment; virtual reality exposure; virtual world; wearable device

Posttraumatic stress disorder (PTSD) is highly prevalent, difficult to treat, and has very serious consequences for veterans and their families. Exposure therapy is commonly used and has positive results in a large percentage of cases, but improvements in therapeutic effects are sorely needed. We propose a novel strategy that uses a combination of state-of-the-art technologies to develop an improved exposure therapy approach. We plan to use a virtual reality experience (Virtual Iraq, in which participants will be virtually driving through Iraqi landscapes where different stressors will be present, such as explosions, enemy combatants, etc.). Virtual reality has already been shown to improve on regular exposure therapy. The main innovation is the use of real time functional MRI (fMRI) during the virtual reality exposure. We will first collect brain images under two clearly defined states: CALM (driving though Iraq with no stressors or war-like scenes) and STRESS (war-like Iraq). We will then use a machine learning algorithm to define those two brain states in terms of neural activity. Next, we will expose participants to a virtual Iraq environment in which they will be able to modify the scenes from stressful to calm, by bringing their brain state to CALM. A real time signal in the screen will let them know where in the continuum CALM-STRESS their brain is at each moment. We hypothesize that this feedback signal will allow for the participant to learn which mental strategies (think pleasant thoughts, concentrate on breathing, etc.) work best in terms of calming the brain. Once the brain moves to CALM, the Virtual Iraq scene will also move to less stressful, providing additional feedback. We propose that this training (two sessions to study individual CALM/STRESS states, 6 sessions of neurofeedback training) will allow patients to develop their own personalized mental strategies to be able to calm their brain in real life, when exposed to triggers. A second innovation is the use of a wearable device to continuously collect physical activity, heart rate, and sleep quality data throughout the 9 weeks of the study. We hypothesize that these measures may result in data more reliable than personal reports during treatment. In conclusion, we propose to use neurofeedback in a virtual reality environment to study the possibility that these real time signals will help veterans with PTSD develop individualized mental strategies to become calm when under stress. Since MRI is very expensive to use as a common intervention, we propose that once we demonstrate the feasibility of the approach on this pilot project, other less expensive and easier to use techniques (perhaps EEG) can be developed based on our data.

创伤后应激障碍（PTSD）是一种高度流行、难以治疗且后果非常严重的疾病 退伍军人和他们的家人。暴露疗法是常用的，并有积极的结果，在一个大的 的百分比的情况下，但在治疗效果的改善是迫切需要的。我们提出了一个新的策略 它结合了最先进的技术来开发一种改进的暴露疗法。 我们计划使用虚拟现实体验（虚拟伊拉克，参与者将虚拟驾驶通过 伊拉克的景观，其中将存在不同的压力源，如爆炸，敌方战斗人员等）。虚拟 现实已经表明，定期暴露疗法会有所改善。主要创新点是采用了真实的 时间功能磁共振成像（fMRI）在虚拟现实曝光。我们将首先收集两个以下的大脑图像 明确定义的状态：平静（在没有压力源或战争场景的情况下驾驶伊拉克）和压力（战争 伊拉克）。然后，我们将使用机器学习算法根据神经活动来定义这两种大脑状态。 接下来，我们将向参与者展示一个虚拟的伊拉克环境，他们将能够修改场景 从紧张到平静，通过把他们的大脑状态带到平静。屏幕上的真实的时间信号会让他们知道 他们的大脑在平静-压力连续体中的位置。我们假设这种反馈 信号将允许参与者学习哪些心理策略（思考愉快的想法，专注于 呼吸等）在镇静大脑方面效果最好。一旦大脑进入平静状态， 也会转移到压力较小的地方，提供额外的反馈。我们建议这次培训（两次会议， 研究个体冷静/压力状态，6次神经反馈训练）将使患者发展 他们自己个性化的心理策略，以便能够在真实的生活中，当暴露于触发器时，使他们的大脑平静下来。 第二个创新是使用可穿戴设备连续收集身体活动、心率和 在整个9周的研究中的睡眠质量数据。我们假设这些措施可能会导致数据 比治疗期间的个人报告更可靠。 总之，我们建议在虚拟现实环境中使用神经反馈来研究以下可能性： 这些真实的时间信号将帮助患有创伤后应激障碍的退伍军人制定个性化的心理策略，使他们变得平静 在压力下。由于MRI作为一种常见的干预手段非常昂贵，我们建议一旦我们 证明这个试点项目的方法的可行性，其他更便宜，更容易使用 技术（也许是脑电图）可以根据我们的数据开发。

项目成果

Orbitofrontal, dorsal striatum, and habenula functional connectivity in psychiatric patients with substance use problems.

• DOI: 10.1016/j.addbeh.2020.106457
• 发表时间: 2020-04
• 期刊: Addictive behaviors
• 影响因子: 4.4
• 作者: Hyuntaek Oh;Jaehoon Lee;Savannah N. Gosnell;M. Patriquin;T. Kosten;R. Salas

Framework for Accurate Classification of Self-Reported Stress From Multisession Functional MRI Data of Veterans With Posttraumatic Stress.

从事创伤后应激的退伍军人的多潜电功能性MRI数据准确分类的自我报告应力的框架。

• DOI: 10.1177/24705470231203655
• 发表时间: 2023-01
• 期刊: Chronic stress (Thousand Oaks, Calif.)
• 作者: Goel, Rahul;Tse, Teresa;Smith, Lia J;Floren, Andrew;Naylor, Bruce;Williams, M Wright;Salas, Ramiro;Rizzo, Albert S;Ress, David
• 通讯作者: Ress, David

Reward processing in psychiatric inpatients with depression.

• DOI: 10.1016/j.bpsc.2021.05.010
• 发表时间: 2021-06
• 期刊: Biological psychiatry. Cognitive neuroscience and neuroimaging
• 作者: Hyuntaek Oh;Jaehoon Lee;M. Patriquin;J. Oldham;R. Salas

Hippocampal Volume in Psychiatric Diagnoses: Should Psychiatry Biomarker Research Account for Comorbidities?

• DOI: 10.1177/2470547020906799
• 发表时间: 2020-01-01
• 期刊: Chronic stress (Thousand Oaks, Calif.)
• 作者: Gosnell, Savannah N;Meyer, Matthew J;Salas, Ramiro
• 通讯作者: Salas, Ramiro

Cingulate Cortex Structural Alterations in Substance Use Disorder Psychiatric Inpatients.

药物使用障碍精神病住院患者的扣带皮层结构改变。

• DOI: 10.1111/ajad.13093
• 发表时间: 2021
• 期刊: The American journal on addictions
• 作者: Oh,Hyuntaek;Gosnell,Savannah;Nguyen,Tien;Tran,Tiffany;Kosten,ThomasR;Salas,Ramiro
• 通讯作者: Salas,Ramiro