Neurocognitive and Neurobehavioral Mechanisms of Change following Psychological Treatment for Alcohol Use Disorder

描述：虽然适度有效的治疗存在酒精使用障碍（AUD），许多人 在完成治疗后复发重度酒精使用，这表明需要更好地了解 有助于取得成功的因素。尽管过去的研究主要集中在 确定哪些治疗方法对AUD有效，直到最近才关注为什么特定的治疗方法 工作，以及治疗导致饮酒变化的机制。这种对机制的关注 行为改变（MOBC）不仅有可能积累有关 治疗过程导致更好的结果，但也可能导致新的治疗方法的发展 或对现有治疗方法的修改，这些治疗方法针对已知导致 改变现有的研究集中在潜在的机制，包括酒精线索反应，影响 监管和行为控制，但这些结构在很大程度上已经使用自我报告的措施进行了测试， 从神经认知的角度来研究这些机制的研究非常少。 为了解决这一知识差距，拟议的研究将在多个层面上研究MOBC，包括自我- 报告，行为表现和神经网络参与，重点是横向和 内侧额叶控制网络、纹状体奖赏网络和杏仁核网络 反应性180名寻求治疗的AUD患者将随机接受 接受4周认知行为治疗（CBT）或基于正念的治疗（MBT）后 为期几周的平台治疗，重点是增强改变的动力。为了建立时间 饮酒变化与这些MOBC变化之间的关系，将在以下方面对患者进行评估：（a） 基线;（B）治疗后4周;（c）治疗后即刻;和（d）治疗后9个月和15个月 基线。在治疗期间，将每月进行一次自我报告测量和行为任务; 将在基线和基线后3个月和9个月收集fMRI。变化之间的关系 将使用先进的混合建模技术来检查拟议的MOBC中的饮酒和变化 这是研究团队开创的。此外，该项目将利用在一个单独的 在非寻求治疗的样本中，使用在类似地点收集的相同措施， 时间点。通过识别CBT或MBT中对饮酒变化有不同贡献的MOBC， 建议的项目不仅可以更深入地了解成功的行为改变，而且可以 为AUD的新型治疗方法的开发提供信息。此外，通过识别神经认知因素， 预测成功的变化，它可能是可能的，利用这一知识，以配合特定的治疗与 特别是病人的神经认知状况

Description: Although modestly effective treatments exist for alcohol use disorders (AUD), many individuals relapse to heavy alcohol use after completing treatment, suggesting the need for a better understanding of factors that contribute to successful outcomes. Whereas much of the focus in past studies has been on identifying what treatments work for AUDs, only recently has there been a focus on why particular treatments work, and the mechanisms by which treatment leads to changes in drinking. This focus on mechanisms of behavior change (MOBCs) has the potential to not only allow for an accumulation of knowledge about the process by which treatment leads to better outcomes, but also may lead to the development of new treatments or modifications of existing treatment approaches that target empirically supported mechanisms known to lead to change. Existing research has focused on potential mechanisms including alcohol cue reactivity, affect regulation, and behavioral control, but these constructs have largely been tested using self-report measures, and there is a noticeable paucity of studies that examine these mechanisms from a neurocognitive perspective. To address this gap in knowledge, the proposed study will examine MOBC at multiple levels including self- report, behavioral performance, and neural network engagement, with a focus on the function of the lateral and medial frontal control networks, striatal based reward networks, and amygdala networks underlying emotional reactivity. One hundred eighty treatment-seeking individuals with an AUD will be randomized to receive either 8 weeks of Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after receiving 4 weeks of a platform treatment that focuses on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in these MOBCs, patients will be assessed at: (a) baseline; (b) four weeks into treatment; (c) immediately post-treatment; and (d) 9- and 15-months post- baseline. Self-report measures and behavioral tasks will be administered at monthly intervals during treatment; and fMRI will be collected at baseline, and at 3, and 9-months post baseline. Relationships between changes in drinking and changes in the proposed MOBCs will be examined using advanced mixed modeling techniques that have been pioneered by the research team. Further, the project will leverage data collected in a separate project examining MOBC in a non-treatment seeking sample using the same measures collected at similar timepoints. By identifying MOBCs of CBT or MBT that differentially contribute to changes in drinking, the proposed project will not only derive a deeper understanding of successful behavior change, but also may inform the development of novel treatments for AUD. In addition, by identifying neurocognitive factors predictive of successful change, it may be possible to utilize this knowledge to match specific treatments with particular patient neurocognitive profiles.