Psychophysiological and Neural Mechanisms of Emotion Dysregulation in Alcohol Disorders Comorbid with PTSD

与 PTSD 共病的酒精障碍中情绪失调的心理生理和神经机制

• 批准号: 8969181
• 负责人: Pilar M Sanjuan
• 金额: $ 23.9万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8969181
• 关键词: Alcohol consumption; Alcohols; Amygdaloid structure; Anger; Arousal; Auditory; Behavior; Behavioral Mechanisms; Beverages; Biological Neural Networks; Brain region; Cognitive; Cognitive Therapy; Comorbidity; Cues; Development; Disease; Distress; Emotional; Emotions; Failure; Fright; Functional Magnetic Resonance Imaging; Functional disorder; Galvanic Skin Response; Generations; Genetic Crossing Over; Goals; Heart Rate; Individual; Insula of Reil; Knowledge; Lateral; Lead; Link; Major Depressive Disorder; Measures; Medial; Mental disorders; Modeling; Moods; National Institute on Alcohol Abuse and Alcoholism; Nature; Neuronal Dysfunction; Neurons; Participant; Patients; Pattern; Physiological; Population Research; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Psychophysiology; Regulation; Relative (related person); Research; Research Design; Research Personnel; Research Project Grants; Respiration; Rewards; Risk; Severities; Sinus Arrhythmia; Stimulus; Stress; Symptoms; System; Testing; Trauma; Treatment Failure; Ventral Striatum; Veterans; Visual; alcohol comorbidity; alcohol craving; alcohol cue; alcohol use disorder; base; cognitive control; craving; design; disorder risk; emotion dysregulation; emotion regulation; emotional reaction; experience; heart rate variability; improved; indexing; negative mood; neural correlate; neurobiological mechanism; neuromechanism; novel; psychosocial; public health relevance; relating to nervous system; respiratory; response; stressor; success; use alcohol to cope

 DESCRIPTION (provided by applicant): Many individuals with alcohol use disorders (AUD) also have posttraumatic stress disorder (PTSD) and these individuals have greater AUD severity than individuals with AUD-only. This study is based on the intersection of research conducted by Drs. Kevin Oschsner and Scott Coffey. Dr. Coffey identified an AUD/PTSD symptom cross-over effect where trauma-related cues elicit not only PTSD symptoms but also alcohol craving. Poor emotion regulation is theorized to underlie this link between AUD and PTSD via a pattern where emotion dysregulation makes individuals both more likely to develop PTSD and also reinforces alcohol use to regulate negative emotions. Dr. Ochsner, meanwhile, has studied emotion regulation extensively in his lab and developed a model of the cognitive control of emotion (MCCE). Within that model there are many different strategies that individuals employ to control emotion. One of these, "reinterpretation," has been the extensively studied and found to be more effective in reducing negative emotions than other strategies. Reinterpretation is based on the premise that emotional reactions to stimuli depend upon the nature of cognitive appraisals of (i.e., the meaning assigned to) stimuli, which is a central tenet of cognitive behavioral therapy. Research has identified aberrant neural processes in AUD and PTSD during stressors. Since these are brain regions and neural networks also associated with emotional control, researchers hypothesize that participants are attempting to regulate emotional responses to these stressful cues but failing. However, we do not know of alcohol comorbidity studies that specifically test the purposeful emotional regulation of stress using a known and well-tested strategy (reinterpretation), or where objective physiological measures of emotion regulation failure are collected, so that abnormal neural networks associated with failures can be objectively identified. In this study we will determine first the ability of particpants with AUD/PTSD, compared to participants with (1) AUD only, (2) PTSD only, and (3) no AUD or PTSD, to regulate emotional responses to personalized trauma cues (symptom provocation). We will also determine whether decreasing emotional responses reduces associated alcohol craving (behavior and subjective distress). Second, we will determine physiological indices (heart rate, skin conductance, heart rate variability) associated with poor emotion regulation (objective measure of distress). Finally, guided by those physiological indices and using fMRI, we will determine neural networks (stress circuit and AUD circuit interaction) associated with dysfunctional emotional regulation. This topic is a priority at NIAAA, who has stated that neurobiological mechanisms underlying AUD/PTSD must be found, and stress circuit and AUD circuit interaction must be clarified. Once these neurobiological mechanisms are identified and the relationship between stress circuits and AUD circuits is clear, we can apply this knowledge to improving treatment approaches, not only for AUD/PTSD patients, but also for those suffering from AUD comorbid with other disorders characterized by emotion regulation problems.

 描述（由申请人提供）：许多患有酒精使用障碍（AUD）的人也患有创伤后应激障碍（PTSD），并且这些人的 AUD 严重程度比仅患有 AUD 的人更严重。这项研究基于 Drs 进行的交叉研究。凯文·奥施纳和斯科特·科菲。科菲博士发现了 AUD/PTSD 症状交叉效应，其中与创伤相关的线索不仅会引发 PTSD 症状，还会引发对酒精的渴望。从理论上讲，情绪调节不良是 AUD 和 PTSD 之间这种联系的基础，情绪调节失调使个体更容易患上 PTSD，而且还会加强饮酒来​​调节负面情绪。与此同时，Ochsner 博士在他的实验室中广泛研究了情绪调节，并开发了情绪认知控制 (MCCE) 模型。在该模型中，个人可以采用许多不同的策略来控制情绪。其中之一“重新解释”已被广泛研究，发现它比其他策略更能有效减少负面情绪。重新解释的前提是，对刺激的情绪反应取决于对刺激的认知评估（即赋予的含义）的性质，这是一个中心原则 的认知行为疗法。研究已经发现 AUD 和 PTSD 在压力期间存在异常的神经过程。由于这些大脑区域和神经网络也与情绪控制有关，研究人员推测参与者试图调节对这些压力线索的情绪反应，但失败了。然而，我们不知道酒精合并症研究使用已知且经过充分测试的策略（重新解释）专门测试有目的的压力情绪调节，或者收集情绪调节失败的客观生理测量，以便可以客观地识别与失败相关的异常神经网络。在本研究中，我们将首先确定患有 AUD/PTSD 的参与者与 (1) 仅 AUD、(2) 仅 PTSD 和 (3) 无 AUD 或 PTSD 的参与者相比，调节对个性化创伤线索（症状激发）的情绪反应的能力。我们还将确定情绪反应的减少是否会减少相关的酒精渴望（行为和主观痛苦）。其次，我们将确定与情绪调节不良（痛苦的客观测量）相关的生理指标（心率、皮肤电导、心率变异性）。最后，在这些生理指标的指导下并使用功能磁共振成像，我们将确定与情绪调节功能失调相关的神经网络（压力回路和 AUD 回路相互作用）。该主题是 NIAAA 的优先事项，NIAAA 表示必须找到 AUD/PTSD 的神经生物学机制，并且必须澄清压力回路和 AUD 回路的相互作用。一旦确定了这些神经生物学机制，并且明确了压力回路和 AUD 回路之间的关系，我们就可以应用这些知识来改进治疗方法，不仅适用于 AUD/PTSD 患者，也适用于那些患有 AUD 并伴有其他以情绪调节问题为特征的疾病的患者。