Brain Biomarkers of Clinical Response to Cognitive Treatment of PTSD in Youth

青少年创伤后应激障碍 (PTSD) 认知治疗临床反应的脑生物标志物

• 批准号: 8641725
• 负责人: AMY S GARRETT
• 金额: $ 17.79万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8641725
• 关键词: Adolescence; Adolescent; Adult; Aftercare; Age; Amygdaloid structure; Behavior Therapy; Biological Markers; Brain; Brain region; Child Abuse; Child Abuse and Neglect; Childhood; Chronic; Clinical; Clinical Research; Clinical Trials; Clinical assessments; Cognitive; Cognitive Therapy; Communities; Consultations; DSM-IV; Development; Diagnostic; Disease; Doctor of Medicine; Emotional; Emotions; Ensure; Ethical Issues; Female; Functional Magnetic Resonance Imaging; Future; Goals; Gold; Hippocampus (Brain); K-Series Research Career Programs; Knowledge; Lead; Leadership; Learning; Literature; Longitudinal Studies; Magnetic Resonance Imaging; Maps; Measures; Medial; Mediator of activation protein; Mentors; Methodology; Methods; Modeling; Participant; Patients; Pattern; Population; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Protocols documentation; Recovery; Recruitment Activity; Research Personnel; Research Project Grants; Sampling; Scanning; Schools; Scientist; Series; Severities; Sexual abuse; Site; Stress; Structure; Supervision; Symptoms; Testing; Training; Trauma; Universities; Youth; age group; arm; base; effective therapy; experience; flexibility; knowledge base; meetings; multidisciplinary; neuroimaging; novel; pediatric trauma; physical abuse; public health relevance; relating to nervous system; research study; response; skills; standard care

DESCRIPTION (provided by applicant): This application will combine the neuroimaging expertise of the investigator with new knowledge of clinical trials methodology and treatment processes. The goal is to produce a unique skill set, ideal for leading interdisciplinary teams of clinicians and basic scientists in studies of brain changes associated with treatment of pediatric trauma-related disorders. The proposed research study will apply this training. We will investigate changes in brain function associated with cognitive behavioral therapy for abused youth suffering from PTSD. Each mentor will provide a specific training component needed for the project. Dr. Stewart Agras, an established leader in clinical trials methodology, will provide in-depth knowledge of the intricacies of conducting high quality clinical trials, and a knowledge base of treatment processes. Dr. Victor Carrion, an expert in pediatric PTSD, will provide understanding of assessment, recruitment, and retention of pediatric PTSD samples. Dr. Carrion also will directly oversee the treatment arm of the research study. Dr. Judith Cohen, co-creator of the treatment used in our study (trauma-focused cognitive-behavioral therapy) will provide a practical understanding of treatment: Dr. Garrett will follow each treatment case during Dr. Cohen's weekly consultations with therapists. Dr. Cohen also will provide guidance on important issues in leading clinical research, including collaborating with multidisciplinary partners, ethical issues, and flexible implementation of treatment fidelity. Dr. Kiki Chang has joined the mentoring team in order to provide a model of a successful neuroimaging treatment study exemplified by his ongoing R01 project. Also, Dr. Garrett will learn about clinical assessment by undergoing in Dr. Chang's established protocol for KSADS reliability training, and attending his mentored diagnostic meetings. Dr. Allan Reiss will ensure excellence in neuroimaging analysis and interpretation, Dr. Booil Jo will provide statistical consultation, and Dr. Greg Siegle will provide guidance in leading CBT treatment-related neuroimaging studies based on his leadership in this field. With the assistance of this comprehensive mentoring team, the proposed research project will provide novel information about the mediators (potential mechanisms) of recovery from PTSD and contribute to the literature on abnormal brain function in pediatric PTSD. In the revised application, we have moved the site of the study to Stanford University, to allow mentors to provide direct ongoing clinical research guidance. Youths will be scanned before and after the 12 week treatment. Analyses will identify treatment-related changes in activation in brain regions implicated in PTSD: the amygdala, hippocampus, and medial prefrontal cortex- and test the associations between changes in activation and improvements in symptoms. Test/retest reliability of fMRI measures will be investigated in a matched control sample scanned at the same interval, and functional connectivity will be analyzed. This study is feasible given the considerable expertise in neuroimaging already established by the applicant, the direct supervision of treatment by mentors, and the support provided by Stanford's clinical research setting. This study will establish Dr. Garrett as an independent scientist in the field of neuroimaging treatment studies in youths with PTSD, and lead to an R01 application that expands and probes the clinical utility of the findings.

描述（由申请人提供）：本申请将将研究者的神经影像学专业知识与临床试验方法和治疗过程的新知识相结合。目的是生产独特的技能，非常适合领先的临床医生跨学科团队和基础科学家，用于研究与小儿创伤相关疾病治疗相关的大脑变化。拟议的研究将应用此培训。我们将研究与患有PTSD的虐待青年有关的脑功能变化。每个导师将提供项目所需的特定培训组成部分。临床试验方法学既定领导者Stewart Agras博士将对进行高质量临床试验的复杂性以及治疗过程的知识基础提供深入的了解。小儿PTSD专家Victor Carrion博士将提供对儿科PTSD样品评估，招聘和保留的理解。 Carrion博士还将直接监督研究研究的治疗部门。我们研究中使用的治疗的共同创建者Judith Cohen博士（以创伤为中心的认知行为疗法）将对治疗方法提供实际的理解：Garrett博士将在Cohen博士每周与治疗师进行每周咨询期间遵循每个治疗案例。 Cohen博士还将在领先的临床研究中提供有关重要问题的指导，包括与多学科合作伙伴合作，道德问题以及灵活地实施治疗保真度。 Kiki Chang博士加入了指导团队，以提供一个成功的神经影像学治疗研究的模型，例如他正在进行的R01项目。此外，加勒特博士将通过在Chang博士为KSADS可靠性培训的既定协议中列出临床评估，并参加他的指导诊断会议。 Allan Reiss博士将确保神经影像学分析和解释方面的卓越表现，Booil Jo博士将提供统计咨询，Greg Siegle博士将根据他在该领域的领导地位领导与CBT治疗相关的神经影像学研究提供指导。在这个全面的指导团队的协助下，拟议的研究项目将提供有关从PTSD恢复的介体（潜在机制）的新信息，并为小儿PTSD中脑功能异常的文献做出了贡献。在修订的应用程序中，我们将研究站点移至斯坦福大学，以允许导师提供直接持续的临床研究指导。在12周治疗之前和之后，将对青年进行扫描。分析将确定与PTSD相关的大脑区域激活的变化：杏仁核，海马和内侧前额叶皮层，并测试激活变化与症状改善之间的关联。 FMRI措施的测试/重新验证可靠性将以相同的间隔扫描的匹配的对照样本进行研究，并将分析功能连接性。鉴于申请人已经建立的神经影像学，导师的直接监督以及斯坦福大学临床研究环境提供的支持，这项研究是可行的。这项研究将在患有PTSD的青年中神经成像治疗研究领域的独立科学家建立Garrett博士，并导致R01应用，该研究扩大并探究了发现的临床实用性。