Response to Unpredictable Threat in Alcohol Dependence and Panic Disorder

描述（由申请人提供）：该奖学金的目标是进一步发展申请人在共病精神病理学，心理生理学和高级统计方法方面的知识和研究技能。与这些目标相一致，申请人培训的基石 将是与拟议的酒精依赖（AD）和惊恐障碍（PD）共病的心理生理过程研究相关的日常活动。该项目将作为申请人的论文工作，并允许她追求她的目标，成为一个独立的研究者，研究与共病物质使用和内化障碍相关的生物行为过程的翻译计划。由于学术临床心理学家的技能是多方面的，拟议的培训计划还包括课程工作，定期赞助商会议，临床实践和专业发展活动。除了申请人获得的技能，该项目也有潜力大大提高我们对共病AD和PD的过程的理解，这一目标与NIAAA和NIMH战略计划的几个方面一致。这一研究领域也值得注意，因为AD-PD与昂贵的社会和经济后果有关，因此具有最大的公共卫生意义。最近有人假设，酒精抑制不可预测的恐慌发作之间的预期焦虑的能力可能是AD-PD的核心机制。证据还表明，AD-PD患者可能会表现出较高的厌恶反应，以应对预期焦虑相对于PD只有个人。然而，这个问题还没有被直接研究，很少有研究评估厌恶的反应如何随着时间的推移而变化。研究进一步表明，长期饮酒会导致呼吸性窦性心律不齐（RSA）的缺陷，这是与厌恶反应相关的一个重要因素，随后可能导致对预期焦虑的反应性/反应增强。因此，该研究的具体目的是检查：1）AD-PD个体是否表现出对不可预测的威胁的反应性增加（即，预期焦虑）与仅PD个体相比，2）AD-PD个体在不可预测的威胁（例如，更少的习惯）相比，PD只有个人，和3）RSA介导这些协会。本研究将招募45名患有AD-PD的个体和45名仅患有PD的个体，并使用完善的EMG惊吓范例评估对不可预测威胁的反应。该项目的导师将由心理生理学和共病精神病理学领域的专家提供。申办者为Shankman和卡塞尔博士，顾问为科廷和Porges博士。该奖学金不仅是申请人研究生涯中的重要一步，而且如果假设得到支持，则表明对预期焦虑的反应性/反应可能是AD-PD的潜在风险因素或后果，因此可能有助于为这种难以治疗的人群制定有针对性的干预措施。

DESCRIPTION (provided by applicant): The goals of this fellowship are to further develop the applicant's knowledge and research skills in comorbid psychopathology, psychophysiology, and advanced statistical methods. In line with these goals, the cornerstone of the applicant's training will be the daily activities associated with the proposed study of psychophysiological processes underlying comorbid alcohol dependence (AD) and panic disorder (PD). The project will serve as the applicant's dissertation work and allow her to pursue her goal of becoming an independent investigator with a translational program of research on biobehavioral processes associated with comorbid substance use and internalizing disorders. As the skills of an academic clinical psychologist are multidimensional, the proposed training plan also includes course work, regular sponsor meetings, clinical practica, and professional development activities. In addition to the skills to be gained by the applicant, the project also has the potenial to greatly advance our understanding of the processes underlying comorbid AD and PD, a goal consistent with several facets of both NIAAA's and NIMH's strategic plans. This area of research is also noteworthy given that AD-PD is associated with costly social and economic consequences and thus, is of the utmost public health significance. It has recently been postulated that alcohol's ability to dampen anticipatory anxiety between unpredictable panic attacks may be a core mechanism in AD-PD. Evidence also suggest that individuals with AD-PD may exhibit heightened aversive reactivity in response to anticipatory anxiety relative to PD-only individuals. However, this question has yet to be directly examined and few studies have assessed how aversive responses change over time. Research further suggests that prolonged alcohol use causes deficits in respiratory sinus arrhythmia (RSA), an important factor associated with aversive responding, which may subsequently lead to heightened reactivity/responding to anticipatory anxiety. As such, the specific aims of the study are to examine whether: 1) AD-PD individuals exhibit increased reactivity to unpredictable threat (i.e., anticipatory anxiety) compared with PD-only individuals, 2) AD-PD individuals exhibit a different time course of aversive responding during unpredictable threat (e.g., less habituation) compared with PD-only individuals, and 3) RSA mediates these associations. Forty-five individuals with AD-PD and 45 individuals with PD-only will be recruited for the present study and responses to unpredictable threat will be assessed using a well-established EMG startle paradigm. Mentorship for this project will be provided by experts in the areas of psychophysiology and comorbid psychopathology. The sponsors are Drs. Shankman and Kassel and the consultants are Drs. Curtin and Porges. This fellowship will not only be an important step in the applicant's research career, but if the hypotheses are supported, it would suggest that reactivity/responding to anticipatory anxiety may be a potential risk factor or consequence of AD- PD and thus, may aid in the development of targeted interventions for this difficult-to-treat population.