Understanding and targeting stress reactivity in women Veterans with alcohol misuse

目标：拟议的CDA-2的总体目标是“了解和瞄准应激反应” 女退伍军人酗酒“，是为应聘者接受辅导培训，并使之发展起来的 在女性退伍军人中进行研究的技能。预计女性将占美国人口的35%。 到2035年，退伍军人将成为VHA用户中增长最快的部分。在这个不断增长的 随着全球人口的增长，了解他们的特殊临床需求将变得越来越重要。酗酒是 对于女性退伍军人来说，一个突出的临床问题。最近对女性终生酒精使用障碍的估计 退伍军人比例高达27%，与男性持平，超过平民女性，以及 酗酒的女性有很高的共发性创伤后应激障碍(PTSD)。培训 CDA-2赠款的目标包括学习新的研究方法，压力的神经生物学标记物和 成瘾、高级统计和职业发展，所有这些都是在改善护理的背景下 女退伍军人。CDA-2项目中提出的研究目的有两个：1.进行随机试验 测试情绪调节技能(认知重新评估)对压力诱导饮酒的影响 酒精滥用和不同程度的共生创伤后应激障碍的女性；2.检查孕酮水平 和/或共患创伤后应激障碍的严重程度--影响女性应激反应和情绪调节的因素 -适度认知重新评估在减少压力导致的饮酒方面的有效性。研究表明， 研究表明，血清孕酮及其代谢产物的水平与应激反应较少有关，较少 对酒精的渴望和使用，以及更好的调节情绪的能力。然而，患有创伤后应激障碍的女性在 黄体酮新陈代谢，女性饮酒和饮酒欲望已被证明是波动的。 月经周期。这项研究表明，孕激素水平较低的女性，在 月经周期阶段或同时发生的创伤后应激障碍，可能特别容易因压力而饮酒，并可能 从学习和使用有效的情绪调节技能中受益。方法：拟议的研究将使用 创新的方法，将随机试验中的实验过程与每日纵向数据相结合 收集。每名女退伍军人(n=60)将被随机分为两种情况之一：对照组(n=30) 或参与者学习使用认知重新评估来调节压力和负面情绪的情况 (n=30)。处于认知重新评估状态的女性将被要求在35天内练习和使用这项技能 (包括整个月经周期)，并将完成每日饮酒和压力记录。每个人 参与者将参加两个实验课程，安排在她的最高峰和最低点 黄体酮水平，在此期间，处于认知重新评估状态的参与者将在 对个性化压力感应的反应。在这些会议中，认知重新评估对 以下变量(在压力诱导后)将被评估：(1)酒精渴求，(2)抑制(认知) 控制，以及(3)生理唤醒(心率变异性)。这三个变量，以及(4)压力诱导 在35天期间饮酒，将是主要的研究结果变量。结果/影响：结果来自 这项研究将加强对退伍军人(有心理健康的女性退伍军人)高危群体的了解 条件)患有老一辈突出疾病(创伤后应激障碍和酗酒)，并推进个性化领域 用药来提高治疗效果。这项研究使用了一种新的方法(“微干预” 设计)，它隔离了治疗策略，通常在更大的治疗方案中传授，以了解他们的 效果。CDA-2中包含的培训和经验将为应聘者提供技能和 研究女性退伍军人的压力、物质使用和认知控制的知识。这条线是 研究和培训将促进应聘者的职业发展，加速她在 成为退伍军人事务部的女性健康研究员。

Objectives: The overall objective of the proposed CDA-2, “Understanding and targeting stress reactivity in women Veterans with alcohol misuse”, is for the candidate to receive mentored training on, and to develop skills for, conducting research among women Veterans. Women are expected to comprise 35% of the U.S. Veteran population by 2035, making them the fastest growing segment of VHA users. Within this growing population, understanding their particular clinical needs will become increasingly important. Alcohol misuse is one clinical issue salient for women Veterans. Recent estimates of lifetime alcohol use disorder among women Veterans are up to 27%, equaling those of their male counterparts and exceeding those of civilian women, and women with alcohol misuse have high rates of co-occurring posttraumatic stress disorder (PTSD). Training goals of the CDA-2 grant include learning novel research methods, neurobiological markers of stress and addiction, advanced statistics, and professional development, all within the context of improving care for women Veterans. Aims for the study proposed in this CDA-2 project are two-fold: 1. conduct a randomized trial testing the effects of an emotion regulation skill (cognitive reappraisal) on stress-induced drinking among women with alcohol misuse and varying levels of co-occurring PTSD; 2. examine whether progesterone levels and/or severity of co-occurring PTSD – factors which impact women’s stress reactivity and emotion regulation – moderate the effectiveness of the cognitive reappraisal in reducing stress-induced drinking. Research has shown that serum levels of progesterone and its metabolites are associated with less stress reactivity, less alcohol craving and use, and better ability to regulate emotion. Women with PTSD, however, exhibit a deficit in progesterone metabolism, and women’s alcohol use and craving has been shown to fluctuate across the menstrual cycle. This research suggests that women with low progesterone levels, within the context of menstrual cycle phase or co-occurring PTSD, may be particularly prone to stress-induced drinking and may benefit from learning and using effective emotion regulation skills. Methods: The proposed study will use innovative methodology, combining experimental sessions in a randomized trial with daily longitudinal data collection. Each woman Veteran (n=60) will be randomized to one of two conditions: a control condition (n=30) or a condition in which participants learn to use cognitive reappraisal to regulate stress and negative emotion (n=30). Women in the cognitive reappraisal condition will be asked to practice and use this skill over a 35-day period (to encompass an entire menstrual cycle), and will complete daily logs of alcohol use and stress. Each participant will come in for two experimental sessions, scheduled at the time of her peak and lowest progesterone levels, during which participants in the cognitive reappraisal condition will use that skill in response to a personalized stress induction. Throughout these sessions, the effect of cognitive reappraisal on the following variables (after the stress induction) will be assessed: (1) alcohol craving, (2) inhibitory (cognitive) control, and (3) physiological arousal (heart rate variability). These three variables, and (4) stress-induced drinking during the 35-day period, will be the main study outcome variables. Results/Implications: Results from this study will enhance knowledge of at-risk groups of Veterans (women Veterans with mental health conditions) with Veteran-salient illnesses (PTSD and alcohol misuse) and advance the field of personalized medicine to improve the effectiveness of treatment. The study uses a novel approach (“microintervention” design) which isolates therapeutic strategies typically taught in larger therapeutic protocols, to understand their effects. The training and experiences included in this CDA-2 will provide the candidate with skills and knowledge in studying stress, substance use, and cognitive control among women Veterans. The line of research and training will facilitate the candidate’s career development, accelerating her progression in becoming a women’s health researcher in the VA.