Enhancing Memory and Learning in Cognitive Processing Therapy for PTSD

项目摘要 创伤后应激障碍是一种高度衰弱和普遍的条件。尽管一些有经验支持的干预措施 存在，回复率不理想。可能阻碍治疗反应的一个因素是编码不良， 巩固和恢复在治疗中发生的学习。患有PTSD的人在一个 与学习和记忆有关的认知领域的数量，特别是在创伤相关的背景下， 刺激和治疗前记忆能力一直被证明可以预测PTSD治疗反应。 此外，对治疗内容的记忆力差是常见的，并且也与较差的治疗有关 结果。因此，本研究将探讨整合记忆支持（MS）的效用。 干预认知加工疗法（CPT），经验支持和广泛传播 治疗PTSD。MS旨在整合旨在促进编码，合并， 并将新的学习检索到现有的治疗中，并已被证明可以改善结果， 整合到抑郁症的认知疗法中拟定研究将包括初始治疗适应性 阶段，以优化MS与CPT的整合，然后进行一项初步随机对照试验，比较CPT 内存支持（CPT+MS）到CPT单独。试验的主要目的是确定是否与 CPT+MS相对于CPT单独治疗（即靶向治疗）将导致更大的治疗内容记忆和学习 参与），并确定将MS纳入CPT的可接受性和可行性。次要目的 包括对治疗效果的初步检查，如PTSD变化的幅度所示。 症状之间的条件，和目标验证，如记忆和 学习治疗内容和治疗反应。探索性分析将检查以下几个指标： 基线记忆相关认知功能作为记忆和学习治疗内容的预测因子， 提供初步数据，为未来个性化应用MS的研究提供信息。试验结果将 推进关于优化记忆和学习的方法的科学知识， 改善创伤后应激障碍的治疗效果拟议的研究和培训计划将有助于申请人 发展成为一个独立的研究者，使用实验治疗方法来增强创伤后应激障碍 治疗结果。指导和培训将侧重于：1）以机制为中心的临床试验方法学; 2)基础学习和记忆研究在评估和改善记忆中的应用 治疗; 3）治疗开发和增强; 4）高级纵向数据分析;以及5） 专业和专业发展。研究和培训将在国家中心进行， 创伤后应激障碍在弗吉尼亚州波士顿医疗保健系统，并将通过指导支持从一个完成 团队致力于申请人的专业发展：塔拉Galovski博士（主要导师），Mieke 作者声明：John W.

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.