Neural Mechanisms of a Novel Psychotherapy in Veterans with PTSD and Alcoholism

患有创伤后应激障碍和酗酒的退伍军人的新型心理治疗的神经机制

• 批准号: 8769102
• 负责人: ANDREA SPADONI TOWNSEND
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8769102
• 关键词: Affect; Affective; Afghanistan; Aftercare; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcoholism; Alcohols; Amygdaloid structure; Anterior; Biological Neural Networks; Brain; Caring; Clinical Practice Guideline; Cognitive Therapy; Comorbidity; Coping Skills; Corpus striatum structure; Cues; Development; Diagnosis; Disease; Disease remission; Drug Addiction; Drug abuse; Effectiveness; Etiology; Exposure to; Functional Magnetic Resonance Imaging; Funding; Goals; Healed; Image; Incidence; Individual; Insula of Reil; Intervention; Intervention Studies; Iraq; Knowledge; Legal; Link; Maintenance; Measures; Medical; Mental disorders; Mission; Neurobiology; Nucleic Acid Regulatory Sequences; Outcome; Participant; Pathogenesis; Patients; Pattern; Play; Population; Post-Traumatic Stress Disorders; Prefrontal Cortex; Psychotherapy; Randomized Controlled Trials; Relative (related person); Research; Rewards; Role; Safety; Services; Severities; Social Problems; Stress; Structure; Substance Use Disorder; Symptoms; Therapeutic; Treatment Efficacy; Treatment outcome; Veterans; Visual; alcohol cue; alcohol use disorder; alternative treatment; base; blood oxygen level dependent; clinical practice; combat; compare effectiveness; cue reactivity; drinking; effective therapy; evidence base; functional outcomes; healing; improved; incentive salience; member; neural circuit; neural correlate; neurobiological mechanism; neuroimaging; neuromechanism; neuropsychiatry; novel; psychologic; psychological outcomes; public health relevance; relating to nervous system; response; tool; treatment effect; treatment response; treatment strategy; trial comparing; trial design

DESCRIPTION (provided by applicant): Rates of posttraumatic stress disorder (PTSD) are high among combat Veterans. Estimates of PTSD within Iraq and Afghanistan Veterans suggest that nearly 17% of active duty and over 24% of reserve service members screen positive for PTSD. Among individuals diagnosed with PTSD, the incidence of drug abuse and addiction is markedly elevated, with the highest comorbidity observed for alcohol use disorders, estimated to be as high as 85% in individuals seeking PTSD treatment. When these comorbidities manifest they result in poorer psychological, functional, and treatment outcomes than either disorder alone. Evidence suggests that neurobiological mechanisms, such as dysregulation of specific brain structures (e.g., amygdala, insula, prefrontal cortex, and striatum) appear to play crucial roles in the maintenance and remission of concurrent AD/PTSD. Currently there are no translational imaging studies that have examined whether patterns of brain activation can predict differences in treatment response in this population, and no attempts have been made to link psychotherapeutic interventions to neurobiological targets in AD/PTSD individuals. Therefore, the long- term goal of this line of research is to use neuroimaging tools to advance our ability to provide optimized, targeted interventions that support improved outcomes for Veterans with AD/PTSD. The objective of this proposal, which is a first step in pursuit of this goal, is to measure the brain response to an anticipatory task and an alcohol cue reactivity task before and after treatment for AD/PTSD in order to 1) delineate a neural profile of treatment responsiveness to empirically supported interventions, and 2) to compare the relative effects of an exposure based to a non-exposure based treatment on the neural substrates thought to maintain these disorders. Participants will receive one of two, 8-week-long, treatments within an ongoing, VA-funded, randomized controlled trial designed to compare the effectiveness of an exposure-based psychotherapy (i.e., Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE)) against the widely used psychotherapy, Seeking Safety (SS), that does not include exposure for the treatment of AD/PTSD. We hypothesize that baseline patterns of brain response will relate to the capacity to improve in the context of therapy, and that the sub-components of COPE and SS will differentially affect change in those neural circuits maintaining AD/PTSD.

描述（由申请人提供）： 退伍军人中创伤后应激障碍（PTSD）的发病率很高。对伊拉克和阿富汗退伍军人中 PTSD 的估计表明，近 17% 的现役军人和超过 24% 的预备役军人的 PTSD 筛查结果呈阳性。在诊断为 PTSD 的个体中，药物滥用和成瘾的发生率显着升高，其中酒精使用障碍的合并症最高，估计在寻求 PTSD 治疗的个体中高达 85%。当这些合并症出现时，它们会导致比单独的任何一种疾病更差的心理、功能和治疗结果。有证据表明，神经生物学机制，例如特定大脑结构（例如杏仁核、岛叶、前额皮质和纹状体）的失调，似乎在 AD/PTSD 并发的维持和缓解中发挥着至关重要的作用。 目前还没有转化成像研究来检验大脑激活模式是否可以预测该人群治疗反应的差异，也没有尝试将心理治疗干预与 AD/PTSD 个体的神经生物学目标联系起来。因此，这方面研究的长期目标是利用神经影像工具来提高我们的能力 提供优化的、有针对性的干预措施，支持改善患有 AD/PTSD 退伍军人的结果。该提案是实现这一目标的第一步，其目的是测量 AD/PTSD 治疗前后大脑对预期任务和酒精线索反应性任务的反应，以便 1) 描绘对经验支持的干预措施的治疗反应性的神经概况，2) 比较基于暴露的治疗与基于非暴露的治疗对被认为维持这些疾病的神经基质的相对影响。参与者将在一项正在进行的、由 VA 资助的随机对照试验中接受两种为期 8 周的治疗之一，该试验旨在比较基于暴露的心理治疗（即，使用长期暴露同时治疗 PTSD 和药物使用障碍 (COPE)）与广泛使用的心理治疗“寻求安全”(SS)，其中不包括治疗 AD/PTSD 的暴露。我们假设大脑反应的基线模式将与治疗背景下改善的能力相关，并且 COPE 和 SS 的子组成部分将对维持 AD/PTSD 的神经回路的变化产生不同的影响。