Imaging Brain Activity in Substance Use Treatment

描述(由申请人提供)：动机访谈(MI)是一种指导性的、以客户为中心的治疗方法，用于治疗药物滥用，具有强有力的有效性证据。到目前为止，在MI中唯一有任何一致经验支持的行动机制是“改变谈话”(CT)，它通常被定义为客户在会话期间口头承诺改变他们的问题行为。“维系对话”包括维持现状的口头承诺。MI坚持认为，在成瘾治疗期间，客户基本上是说服自己改变。多项研究支持这一理论，揭示了MI治疗过程中这些改变谈话话语的频率和强度预测了物质使用结果。虽然现在已经建立了将治疗师的讲话、客户的改变谈话和物质使用结果联系起来的因果链，但改变谈话的神经基础在很大程度上仍然是未知的。这份K01提案旨在探索这种神经基质。基于动机访谈中因果机制的研究结果，这一应用程序代表了一种努力，以确定在治疗过程中基于生物学的过程，这些过程是治疗过程中客户改变谈话的基础，长期目标是了解如何更有效和更有力地激发这种过程来改善药物滥用结果。此外，这项研究的目的是为我作为一名独立临床科学家的职业生涯做好准备提供重要的培训。我目前的职业目标是：(1)获得酒精使用障碍的内表型方面的专家级知识，(2)加深我对高级分析方法的知识，包括网络级功能神经成像分析和纵向数据分析，以及(3)发展我的科学和拨款撰写技能。我的首要目标是成为一名独立的临床科学家，并在应用神经成像方法研究药物滥用治疗中行为变化机制方面处于领先地位。在Barbara McCrady博士领导的指导团队的指导下，包括Vince Calhoun博士、Theresa Moyers博士和Claudia Tesche博士在内的指导团队，我将在一个实际的MI会议期间使用脑磁图(MEG)在一个矛盾的酒精使用者样本中探索改变谈话的神经基础。在随后的测量会话中，我将使用脑磁图来测量大脑对客户自己的变化谈话的简短话语的反应，以及从MI会话中记录的持续谈话。通过这种方式，我可以探索在MI会话中最初表达变化谈话时测量的大脑活动之间的差异，以及通过使用客户的变化谈话录音进行后续测量时测量的大脑活动之间的差异。我还将使用独立成分分析来检验改变谈话和持续谈话之间的大脑活动差异，并测试大脑活动与物质使用结果之间的关系。从长远来看，这些信息可以用来改进激励性访谈，更精确地瞄准突出的大脑区域和过程，以实现最有效和最有力的变革言论表达，这最终可能导致改善药物滥用结果。

DESCRIPTION (provided by applicant): Motivational interviewing (MI) is a directive, client-centered therapeutic method employed in the treatment of substance abuse, with strong evidence of effectiveness. To date, the sole mechanism of action in MI with any consistent empirical support is "change talk" (CT), which is generally defined as in-session verbal commitments by clients to change their problem behavior. "Sustain talk" (ST) incorporates verbal commitments to maintain the status quo. MI maintains that during addiction treatment clients essentially talk themselves into change. Multiple studies have supported this theory, revealing that the frequency and strength of these change talk utterances from MI treatment sessions predict substance use outcomes. Although a causal chain has now been established linking therapist speech, client change talk, and substance use outcomes, the neural substrate of change talk remains largely uncharted. This K01 proposal is designed to explore that neural substrate. Building upon the results of studies of causal mechanisms in motivational interviewing, this application represents an effort to identify biologically-based processes that underlie client change talk during treatment sessions, with the long-term goal of understanding how it might be more efficiently and powerfully elicited to improve substance abuse outcomes. Furthermore, this study is designed to provide important training to prepare me for a career as an independent clinical scientist. My immediate career goals are to: (1) acquire expert-level knowledge about endophenotypes in alcohol use disorders, (2) deepen my knowledge about advanced analysis methodologies including network- level functional neuroimaging analysis and longitudinal data analysis, and (3) develop my scientific and grant writing skills. My overarching goal is to become an independent clinical scientist and a leader in the application of neuroimaging methodologies to study mechanisms of behavior change in substance abuse treatment. Under the guidance of a mentoring team led by Dr. Barbara McCrady and including Dr. Vince Calhoun, Dr. Theresa Moyers, and Dr. Claudia Tesche, I will explore the neural substrate of change talk during an actual MI session using magnetoencephalography (MEG) in a sample of ambivalent alcohol users. In subsequent measurement sessions I will use MEG to measure brain responses to brief utterances of the client's own change talk and sustain talk recorded from that MI session. In this way I can explore differences between brain activity measured when change talk is originally expressed within an MI session, and that measured in follow- up measurements using recordings of the client's change talk. I will also examine differences in brain activity between change talk and sustain talk using independent component analysis, and test for relationships between brain activity and substance use outcomes. In the long term this information could be used to develop refinements to motivational interviewing, targeting the salient brain regions and processes more precisely in order to achieve the most efficient and powerful expressions of change talk, which could ultimately lead to improved substance abuse outcomes.