Behavioral Strategies to Reduce Stress Reactivity in Opioid Use Disorder

项目摘要/摘要 作为对RFA-RM-17-028的回应，我们建议调查行为策略对减少 阿片类药物使用障碍成人的应激反应。阿片类药物滥用在美国已达到流行水平 2015年，有超过1250万人滥用处方阿片类药物，超过90万人使用海洛因。在……里面 2015年，超过3.3万人死于阿片类药物过量，继续自2015年以来死亡人数有增无减 20世纪90年代末。尽管丁丙诺啡维持等治疗已被证明对 治疗阿片类药物使用障碍，复发仍然非常普遍。对压力的高度反应性(即， 对压力源的情感和生理反应)与复发风险密切相关；然而，存在 治疗对应激反应几乎没有影响。因此，显然需要新的干预措施来 减少阿片类药物使用障碍患者的应激反应。与以机制为重点的实验一致 行为改变研究的医学方法，我们建议检验短暂的认知-行为的效果 对(1)应激反应的情感和生理标记物(靶)的影响调节干预 参与)，以及(2)短期行为改变(压力背景下的行为坚持)。 参与者将被随机分配到一种控制条件或两种简短的影响规则之一 干预，包括有意的情感调节策略(认知重新评估)或 附带影响调节策略(影响标签)。这两种策略已经被证明产生了相似的结果 减少对情感刺激的反应，但需要不同水平的认知资源，因此 代表了两种不同的减少应激反应的方法。第一个目标是确定 相对于控制条件，对应激源的反应性的有意和偶然影响调节策略。 第二个目标是确定这些情绪调节策略和行为之间的关联 对压力源的耐受性。作为次要目标，我们将调查基线(即干预前)水平 自我调节的影响与这些影响调节策略有关。具体来说，我们将 调查那些自我监管缺陷的人是否对影响监管的反应减少 干预措施以及它们对有意策略和偶然策略的反应是否不同(例如，是否 有自我调节缺陷的人对附带情感调节策略的反应更大，这需要 更少的认知资源)。如果我们的假设得到支持，这一信息可以用来告知 开发全程多疗程认知行为疗法以改善这些患者的预后 有阿片类药物使用障碍。关键是，因为应激反应与一系列精神病患者 精神障碍(酒精使用障碍、创伤后应激障碍)，这些发现也可能对 其他心理健康状况下的行为改变。

Project Summary/Abstract In response to RFA-RM-17-028, we propose to investigate the impact of behavioral strategies for reducing stress reactivity in adults with opioid use disorder. Opioid misuse has reached an epidemic level in the United States, with over 12.5 million people misusing prescription opioids and over 900,000 using heroin in 2015. In 2015, over 33,000 people died from opioid overdose, continuing the unabated escalation of deaths since the late 1990s. Although treatments such as buprenorphine maintenance have been shown to be effective for the treatment of opioid use disorder, relapse remains highly prevalent. Heightened reactivity to stress (i.e., affective and physiological response to stressors) is robustly associated with risk for relapse; however, existing treatments have little impact on stress reactivity. Accordingly, there is a clear need for novel interventions to reduce stress reactivity in those with opioid use disorder. Consistent with a mechanisms-focused experimental medicine approach to behavior change research, we propose to test the effect of brief cognitive-behavioral affect regulation interventions on (1) affective and physiological markers of reactivity to stress (target engagement), and (2) short-term behavior change (behavioral persistence in the context of stress). Participants will be randomly assigned to either a control condition or one of two brief affect regulation interventions, consisting of either an intentional affect regulation strategy (cognitive reappraisal) or an incidental affect regulation strategy (affect labeling). These two strategies have been shown to yield similar reductions in response to affective stimuli, but require different levels of cognitive resources, and thus represent two distinct approaches to reducing stress reactivity. The first aim is to determine the impact of intentional and incidental affect regulation strategies on reactivity to a stressor relative to a control condition. The second aim is to determine the association between these affect regulation strategies and behavioral tolerance to a stressor. As a secondary aim, we will investigate whether baseline (i.e., pre-intervention) levels of self-regulation are associated with the impact of these affect regulation strategies. Specifically, we will investigate whether those with self-regulatory deficits have a reduced response to affect regulation interventions and whether they respond differently to intentional vs. incidental strategies (e.g., whether those with self-regulatory deficits exhibit greater responding to an incidental affect regulation strategy, which requires fewer cognitive resources). If our hypotheses are supported, this information can be used to inform the development of a full dose of multi-session cognitive-behavioral therapy for improving outcomes among those with opioid use disorder. Critically, because of the relevance of stress reactivity across an array of psychiatric disorders (alcohol use disorder, posttraumatic stress disorder), these findings may also have implications for behavior change for other mental health conditions.