Repetitive Transcranial Magnetic Stimulation Augmented Written Exposure Therapy for Veterans with PTSD

针对患有 PTSD 的退伍军人的重复经颅磁刺激增强书面暴露疗法

• 批准号: 10402838
• 负责人: Crystal Lantrip
• 金额: --
• 依托单位: OLIN TEAGUE VETERANS CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402838
• 关键词: Affect; Affective; Affective Symptoms; Appointment; Area; Attention; Award; Behavior Therapy; Behavioral Mechanisms; Brain; Centers of Research Excellence; Clinic; Clinical; Clinical Treatment; Clinical Trials; Cognition; Cognitive; Collaborations; Dedications; Diagnosis; Diagnostic; Dose; Double-Blind Method; Down-Regulation; Effectiveness; Electromagnetics; Emotional; Emotions; Fellowship; Freedom; Future; Goals; Healthcare; Individual Differences; Intervention; Investigation; Length; Magnetism; Mediating; Mediator; Mental Depression; Mental Health; Mental disorders; Mentors; Mission; Neurons; Outcome; Patients; Phase; Physiologic pulse; Positioning Attribute; Post-Traumatic Stress Disorders; Postdoctoral Fellow; Prefrontal Cortex; Process; Property; Psychotherapy; Quality of Care; Randomized; Randomized, Controlled Trials; Research; Research Personnel; Sampling; Scalp structure; Site; Stimulus; Symptoms; Testing; Time; Training; Trauma; Treatment Effectiveness; Treatment Protocols; Treatment outcome; Up-Regulation; Veterans; War; Woman; Work; Writing; behavioral study; brain based; brain behavior; care burden; career; cognitive control; cognitive enhancement; effective intervention; effective therapy; emotion dysregulation; emotion regulation; evidence base; experience; flexibility; improved; men; neural; neuromechanism; novel; operation; reduce symptoms; repetitive transcranial magnetic stimulation; symptomatic improvement; theories; trauma exposure; treatment effect; treatment-resistant depression

Post-traumatic stress disorder (PTSD) is highly prevalent among post-deployment Veterans. First line evidence-based psychotherapies (EBPs) for PTSD can be effective, but have limitations including high attrition rates, due in part to lengthy treatment protocols, and continued diagnosis of PTSD in a significant number of patients despite treatment completion. Alternate brain-based treatments are thus being explored, like repetitive transcranial magnetic stimulation (rTMS ), which is useful for depression and shows promise for PTSD. rTMS involves applying a repetitive, brief magnetic pulse to the scalp in order to safely modulate cortical neurons via the dorsolateral prefrontal cortex node, which is believed to improve control of cognition and emotions. Standard rTMS treatments are stand-alone, though the unique properties of rTMS enhancing cognitive control may make it more effective when added to an EBP for PTSD. A brief EBP for PTSD that is effective in as few as five sessions with limited attrition is written exposure therapy (WET). Integration of rTMS with WET could improve efficacy by improving emotional control-dependent cognitive restructuring, which is believed to be WET’s mechanism of action. However, this possibility has not been tested. The applicant, Dr. Lantrip, is a clinical neuropsychologist with expertise in brain -behavior relationships. She has significant experience studying behavioral and neural regulatory processes impacting mental health. Through her postdoctoral fellowship, she developed a theoretical framework for understanding the emotion regulatory mechanisms contributing to symptom improvement in rTMS for depression. She tested this theory in an rTMS clinical trial. Through her current primary VA appointment at the VISN 17 Center of Excellence for Research on Returning War Veterans, Dr. Lantrip has access to a large pool of Veterans with PTSD as well as to a research-dedicated TMS machine. Further, Dr. Lantrip has established collaborations with external researchers who are experts in rTMS treatment in Veterans and in WET. In short, Dr. Lantrip is in an ideal position to conduct the necessary research to augment behavioral therapy for PTSD with rTMS. In the proposed randomized controlled trial, Dr. Lantrip will compare active rTMS added to WET with sham rTMS added to WET in [98] Veterans with PTSD. She will also determine the mechanism of action of the treatment by determining if emotional flexibility is a mediator of treatment outcome. In summary, this project will attempt to augment WET, a brief EBP for PTSD, by adding rTMS, and it will also attempt to determine the emotion regulatory mechanism of action for symptom improvement. If successful, this work will influence both clinical treatment and scientific investigation of PTSD. This project will be of potentially great value to both patients and clinicians within the VA by providing an effective, efficient treatment option for veterans with PTSD. This treatment may also facilitate symptom improvement in transdiagnostic mental health disorders. Upon successful completion of this project, Dr. Lantrip will apply for a VA Merit Review Award with continued investigation into TMS-augmented behavioral intervention for trauma-related illness. By providing Dr. Lantrip with mentored research time to conduct this study, this project will help Dr. Lantrip achieve her goal of becoming an independent VA investigator.

创伤后应激障碍（PTSD）在部署后退伍军人中非常普遍。第一 针对PTSD的循证心理疗法（EBP）是有效的，但也有局限性 包括高流失率，部分原因是长期的治疗方案，以及持续的诊断， 尽管治疗完成，仍有相当数量的患者患有PTSD。替代的基于大脑的 因此，正在探索治疗方法，如重复经颅磁刺激（rTMS）， 对抑郁症很有用，对创伤后应激障碍也很有希望。rTMS涉及应用重复的，简短的 向头皮施加磁脉冲，以便通过背外侧安全地调节皮质神经元 前额叶皮层节点，这被认为是提高控制的认知和情绪。标准 rTMS治疗是独立的，尽管rTMS增强认知能力的独特特性 控制可能会使它更有效时，添加到EBP的创伤后应激障碍。一个简短的EBP创伤后应激障碍， 有效的，在短短五个会议与有限的磨损是书面暴露疗法（WET）。 rTMS与WET的整合可以通过改善情绪控制依赖性来提高疗效 认知重构，这被认为是WET的作用机制。但这 可能性还没有被测试。 申请人兰特里普博士是一名临床神经心理学家，擅长大脑行为 关系。她在研究行为和神经调节过程方面有着丰富的经验 影响心理健康通过她的博士后研究，她开发了一个理论 理解情绪调节机制的框架有助于症状 改善抑郁症的rTMS。她在rTMS临床试验中测试了这一理论。通过她 目前主要VA任命在VISN 17卓越中心的研究返回 战争退伍军人，Lantrip博士有机会接触到大量患有创伤后应激障碍的退伍军人， 研究专用的TMS机器此外，Lantrip博士还与外部合作伙伴建立了合作关系。 他们是退伍军人和WET中rTMS治疗的专家。简而言之，兰特里普博士 一个理想的位置，进行必要的研究，以加强行为治疗创伤后应激障碍， rTMS。 在拟议的随机对照试验中，Lantrip博士将比较WET中添加的活性rTMS 在WET中添加假rTMS [98]患有PTSD的退伍军人。她还将决定 治疗的作用机制，通过确定情绪灵活性是否是 治疗结果 总之，该项目将试图通过增加rTMS来增加WET，这是一种用于PTSD的简短EBP， 并试图确定症状的情绪调节作用机制 改进.如果成功，这项工作将影响临床治疗和科学研究。 PTSD的调查该项目将对患者和临床医生具有潜在的巨大价值 通过为患有创伤后应激障碍的退伍军人提供有效，高效的治疗选择，在退伍军人事务部内。这 治疗还可促进转诊断精神健康障碍的症状改善。 成功完成本项目后，Lantrip博士将申请VA Merit Review Award， 继续研究TMS增强的创伤相关疾病行为干预。通过 为Lantrip博士提供指导研究时间来进行这项研究，该项目将有助于Lantrip博士。 Lantrip实现了她成为独立VA调查员的目标。