Enhancing Memory and Learning in Cognitive Processing Therapy for PTSD

项目摘要 创伤后应激障碍是一种非常虚弱和普遍的疾病。尽管一些经验性的干预措施 存在，响应率是次优的。一个可能阻碍治疗反应的因素是糟糕的编码， 巩固和恢复在治疗中发生的学习。患有创伤后应激障碍的个体在 与学习和记忆有关的认知域的数量，特别是在与创伤有关的背景下 刺激和治疗前的记忆能力一直被证明可以预测创伤后应激障碍的治疗反应。 此外，对治疗内容的记忆力差是很常见的，也与较差的治疗有关。 结果。因此，本研究将考察整合记忆支持(MS)的效用 对认知加工疗法(CPT)的干预--一种得到经验支持和广泛传播的方法 创伤后应激障碍的治疗。MS旨在集成旨在促进编码、合并、 并将新的学习恢复到现有的治疗中，并已被证明在以下情况下可以改善结果 整合到抑郁症的认知疗法中。拟议的研究将包括初步的治疗适应。 阶段以优化MS与CPT的整合，随后进行试点随机对照试验比较CPT 将内存支持(CPT+MS)升级到CPT-Only。试验的主要目的将是确定是否将 与单独使用CPT(即靶点)相比，CPT+MS将导致对治疗内容的更大记忆和学习 参与)，并确定将MS整合到CPT中的可接受性和可行性。次要目标 包括初步检查治疗效果，如创伤后应激障碍的变化幅度所示 条件和目标验证之间的症状，如记忆和目标验证之间的关联所指示的 学习治疗内容和治疗反应。探索性分析将考察以下几个指标 基线记忆相关的认知功能是治疗内容记忆和学习的预测因子， 提供初步数据，为今后关于MS个性化应用的研究提供信息。试验结果将 关于优化记忆和学习作为一种机制的方法的高级科学知识 改善创伤后应激障碍的治疗结果。拟议的研究和培训计划将有助于申请者 发展成为一名独立的研究人员，使用实验治疗学方法来加强创伤后应激障碍 治疗结果。指导和培训将集中在：1)以机制为重点的临床试验方法学； 2)基础学习记忆研究在评估和改善儿童记忆能力中的应用 治疗；3)治疗的发展和加强；4)先进的纵向数据分析；和5) 勇于奉献精神和职业发展。研究和培训将在国家研究中心进行 退伍军人事务部波士顿医疗系统的创伤后应激障碍，并将通过已完成的 致力于申请者专业发展的团队：Tara Galovski博士(主要导师)，Mieke Verfaellie，Suzanne Pineles和Brian Smith。

Project Summary PTSD is a highly debilitating and prevalent condition. Although a number of empirically supported interventions exist, response rates are suboptimal. One factor likely impeding treatment response is poor encoding, consolidation, and retrieval of the learning that occurs in therapy. Individuals with PTSD exhibit deficits in a number of cognitive domains related to learning and memory, particularly in the context of trauma-related stimuli, and pre-treatment memory capacity has consistently been shown to predict PTSD treatment response. Furthermore, poor memory of therapy content is common and is also associated with worse treatment outcome. Accordingly, the present study will examine the utility of integrating a Memory Support (MS) intervention into Cognitive Processing Therapy (CPT), an empirically supported and widely disseminated treatment for PTSD. MS was designed to integrate techniques aimed at facilitating encoding, consolidation, and retrieval of new learning into existing treatments, and has been shown to improve outcomes when integrated into cognitive therapy for depression. The proposed study will consist of an initial treatment adaption phase to optimize integration of MS into CPT, followed by a pilot randomized controlled trial comparing CPT with Memory Support (CPT+MS) to CPT-alone. The primary aim of the trial will be to determine if compared CPT+MS will lead to greater memory and learning of therapy content relative to CPT-alone (i.e. target engagement), and to establish the acceptability and feasibility of integration of MS into CPT. Secondary aims include a preliminary examination of treatment efficacy, as indicated by the magnitude of changes in PTSD symptoms between conditions, and target validation, as indicated by associations between memory and learning of therapy content and treatment response. Exploratory analyses will examine several indicators of baseline memory-related cognitive functioning as predictors of memory and learning of therapy content, providing preliminary data to inform future research on personalized application of MS. Results of the trial will advance scientific knowledge about methods for optimizing memory and learning as a mechanism for improving PTSD treatment outcomes. The proposed research and training plan will facilitate the applicant’s development into an independent investigator using an experimental therapeutics approach to enhance PTSD treatment outcomes. Mentorship and training will focus on: 1) mechanisms-focused clinical trial methodology; 2) application of basic learning and memory research to the assessment and improvement of memory during therapy; 3) treatment development and enhancement; 4) advanced longitudinal data analysis; and 5) grantsmanship and professional development. Research and training will take place at the National Center for PTSD at the VA Boston Healthcare System, and will be supported through mentorship from an accomplished team committed to the applicant’s professional development: Drs. Tara Galovski (primary mentor), Mieke Verfaellie, Suzanne Pineles and Brian Smith.