Electrophysiological Predictors and Indicators of Contingency Management Treatment Response

电生理学预测因素和应急管理治疗反应指标

• 批准号: 10417037
• 负责人: SARAH E FORSTER
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10417037
• 关键词: Abstinence; Affect; Aftercare; Area; Base of the Brain; Behavior Therapy; Behavior assessment; Behavioral; Brain; Cessation of life; Clinical; Clinical Trials; Cocaine; Cocaine Dependence; Cocaine Users; Cocaine use disorder; Cognitive; Cost Measures; Custom; Data; Decision Making; Development; Diagnosis; Disease; Drug Screening; Drug Use Disorder; Effectiveness; Electroencephalography; Electrophysiology (science); Ethics; Evaluation; Event-Related Potentials; Fostering; Future; Goals; Homelessness; Hospitalization; Impairment; Imprisonment; Incentives; Individual; Individual Differences; Inherited; Intervention; Knowledge; Measurement; Measures; Mental Health; Methods; Mind; Modeling; Motivation; Neurocognitive; Opiate Addiction; Outcome; Outpatients; Participant; Patient Self-Report; Pattern; Performance; Pharmaceutical Preparations; Pharmacotherapy; Post-Traumatic Stress Disorders; Predictive Analytics; Prize; Probability; Process; Provider; Psychological reinforcement; Recovery; Recovery Support; Relapse; Reporting; Research; Research Training; Rewards; Self Efficacy; Self-control as a personality trait; Services; Severities; Short-Term Memory; Signal Transduction; Site; Substance Use Disorder; Targeted Research; Testing; Thinking; Training; Translations; Treatment Effectiveness; Treatment outcome; Urine; Variant; Veterans; Work; addiction; base; behavior measurement; behavioral health; clinical decision-making; clinically relevant; cognitive ability; cognitive control; cognitive function; contingency management; disorder later incidence prevention; evidence base; financial incentive; implementation barriers; implementation cost; improved; individual patient; individual response; military veteran; neuroadaptation; novel; opioid use disorder; predictive modeling; premature; programs; recruit; relating to nervous system; response; reward anticipation; scaffold; service member; substance use; substance use treatment; targeted treatment; treatment as usual; treatment planning; treatment response; voucher

Electrophysiological methods, including event-related potential and functional connectivity approaches, have strong potential to clarify mechanisms of substance use treatment response and characterize individual differences therein. Veterans are disproportionately affected by disorders of addiction, of which cocaine use disorder (CUD) is particularly problematic due to high relapse rates and the absence of approved pharmaco- therapy treatment options. Behavioral interventions for CUD, have therefore become an important focus of research and Contingency Management (CM) has emerged as the best-supported and most widely used approach. CM involves reinforcing cocaine abstinence (established through objective testing) with reliable, short-term reward, such as chances to win prizes (i.e., Prize-Based CM or PBCM). In response to substantial empirical support, national dissemination of PBCM has been supported by a VHA initiative since 2011. However, PBCM response rates are variable and long-term benefits are limited – problems magnified by the cost of implementation with respect to staffing and prizes. Measurement-based approaches to PBCM implementation have strong promise to improve the effectiveness and efficiency of CM programming but have not yet been investigated within the VA or considered in relation to promising neuromarkers. Importantly, two versions of PBCM are already utilized at VA sites and may differentially benefit individuals with distinct neurocognitive profiles. Specifically, VA PBCM programs employ either abstract (voucher prize) or concrete (tangible prize) incentives, the latter of which may more effectively incentivize abstinence in Veterans with poor future-oriented thinking and planning ability. While selection between existing PBCM variants is currently driven by practical considerations (e.g., provider convenience), measurement of pretreatment neurocognitive functioning could meaningfully and realistically inform clinical decision-making in this regard. This CDA aims to advance measurement-based implementation of CM by testing a novel neurocognitive model of CM with immediate implications for the use of abstract versus concrete PBCM incentives within the VA. Specifically, the future-minded decision-making (FMDM) model posits that CM scaffolds future-oriented goal representation and self-control to support abstinence during in the moment use-related decision-making. For individuals with greater FMDM impairment, concrete, readily-accessible incentives may be more effective than abstract monetary rewards (e.g., vouchers) which require future-oriented thinking and planning to inherit value. To test this model, neurocognitive substrates of FMDM will be examined as predictors of differential treatment response in voucher (VoucherPBCM) versus tangible prize (TangiblePBCM) versions of the intervention used within the VA. Treatment-related change in neural and cognitive-behavioral correlates of FMDM will also be evaluated in PBCM relative to treatment-as-usual (TAU) care. A total of 180 Veterans with CUD will be allocated to VoucherPBCM (n=70), TangiblePBCM (n=70), or TAU (n=40) conditions and followed for a 12 week treatment interval. Pre- and post-treatment electroencephalography (EEG) and cognitive-behavioral assessments will be used to measure FMDM-related constructs (working memory, self- control, future-oriented decision-making, future reward representation) and related neuromarkers. These measures will subsequently be investigated as predictors of differential treatment response in VoucherPBCM versus Tangible PBCM. Longitudinal change in FMDM-related neural substrates and cognitive abilities will also be evaluated for evidence of neuroadaptation (e.g., changes in functional connectivity) and enhancement of FMDM function through PBCM. The proposed research will be supported by focused training in the areas of (1) predictive analytics, (2) functional connectivity analysis of EEG data, (3) longitudinal evaluation of neuroadaptive mechanisms, and (4) clinical trials research. Together, research and training aims will support development of an independent program of research targeting precision implementation of CM within the VA.

电生理方法，包括事件相关电位和功能连接方法， 有很强的潜力来阐明药物使用治疗反应的机制并确定个体的特征 它们之间的差异。退伍军人受成瘾障碍的影响不成比例，其中可卡因的使用 精神障碍(CUD)的问题尤其严重，因为复发率很高，而且没有经过批准的药物- 治疗方案。因此，对CUD的行为干预已经成为一个重要的焦点 研究和应急管理(CM)已经成为得到最好支持和最广泛使用的 接近。CM涉及加强可卡因戒断(通过客观测试确定)， 短期奖励，例如获奖机会(即基于奖品的CM或PBCM)。为了回应实质性的 在经验支持方面，自2011年以来，自愿捐款倡议一直支持多民族玻利维亚国在全国的传播。 然而，PBCM的响应率是可变的，长期利益是有限的-问题被放大了 人员编制和奖金方面的执行费用。基于测量的PBCM方法 实施有很大希望提高CM编程的有效性和效率，但 尚未在退伍军人管理局内进行调查，或被认为与有前景的神经标志物有关。重要的是，两个 不同版本的PBCM已经在退伍军人事务部使用，可能会让不同的个人受益不同 神经认知特征。具体地说，退伍军人管理局PBCM计划采用抽象(代金券奖励)或具体 (有形奖励)激励，后者可能更有效地激励退伍军人禁欲 面向未来的思考和规划能力差。而现有的PBCM变体之间的选择是 目前受实际考虑(例如，提供者便利性)、前处理措施的驱动 神经认知功能可以在这方面为临床决策提供有意义和现实的信息。 此CDA旨在通过测试一种新的神经认知来推进基于测量的CM的实施 CM模型，对于使用抽象的与具体的PBCM激励在 弗吉尼亚州具体地说，面向未来的决策(FMDM)模型假定CM是面向未来的 目标表征和自我控制在与使用相关的决策过程中支持禁欲。 对于FMDM损伤较大的个人来说，具体的、容易获得的激励措施可能更有效 而不是抽象的金钱奖励(例如，代金券)，它需要面向未来的思维和规划来继承 价值。为了验证这一模型，我们将考察FMDM的神经认知底物作为差异的预测因子。 优惠券(Voucher PBCM)与有形奖品(TanyblePBCM)版本中的治疗反应 退伍军人事务部内部使用的干预措施。与治疗相关的神经和认知行为相关性的变化 FMDM也将在PBCM中相对于照常治疗(TAU)护理进行评估。共有180名退伍军人 CUD将分配给Voucher PBCM(n=70)、TanyblePBCM(n=70)或TAU(n=40)条件 治疗间隔12周。治疗前后的脑电(EEG)和 认知-行为评估将用于测量与FMDM相关的结构(工作记忆、自我 控制、面向未来的决策、未来奖励表征)和相关的神经标记物。这些 随后将研究措施作为Voucher PBCM区别治疗反应的预测因素 与有形的PBCM相比。FMDM相关神经底物和认知能力的纵向变化也将 评估神经适应的证据(例如，功能连通性的变化)和增强 FMDM通过PBCM发挥作用。拟议的研究将得到以下领域的重点培训的支持： 预测分析，(2)脑电数据的功能连通性分析，(3)纵向评估 神经适应机制；(4)临床试验研究。研究和培训目标将共同支持 制定一个独立的研究计划，目标是在退伍军人事务部内精确实施CM。