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

酒精使用障碍心理治疗后的神经认知和神经行为变化机制

• 批准号: 9906153
• 负责人: Eric D Claus
• 金额: $ 61.33万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-05 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9906153
• 关键词: Address; Affect; Aftercare; Alcohol abuse; Alcohol consumption; Alcohols; Amygdaloid structure; Arousal; Basic Science; Behavior Control; Behavior assessment; Behavioral; Behavioral Mechanisms; Characteristics; Client; Clinical Trials; Cognitive Therapy; Communities; Corpus striatum structure; Cues; Data; Development; Early treatment; Emotional; Functional Magnetic Resonance Imaging; Future; Goals; Heavy Drinking; Individual; Knowledge; Lateral; Lead; Measures; Medial; Mediating; Mindfulness Training; Modeling; Modification; Motivation; Neurocognitive; Outcome; Participant; Patient Self-Report; Patients; Pattern; Performance; Predictive Factor; Process; Public Health; Randomized; Randomized Clinical Trials; Recovery; Regulation; Relapse; Reporting; Research; Rewards; Sampling; Techniques; Testing; Time; Treatment outcome; Vision; Work; alcohol abstinence; alcohol abuse therapy; alcohol cue; alcohol use disorder; base; behavior change; blood oxygenation level dependent response; cognitive change; cognitive control; cognitive enhancement; comparison group; craving; cue reactivity; design; drinking; drinking behavior; effective therapy; executive function; falls; improved; individualized medicine; meetings; negative affect; neural network; neurobehavioral; neuroimaging; neuromechanism; novel; performance based measurement; psychologic; public health relevance; recruit; response; secondary analysis; skills; treatment group

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.

描述：尽管酒精使用障碍(AUD)有适度有效的治疗方法，但许多人 在完成治疗后再次酗酒，这表明有必要更好地了解 有助于取得成功结果的因素。尽管过去的研究主要集中在 确定哪些治疗方法对AUDS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。这一重点是在机制上 行为改变(MOBC)不仅可能允许积累关于 治疗带来更好结果的过程，但也可能导致新治疗方法的发展 或对现有治疗方法的修改，这些方法针对已知的有经验支持的机制 去改变。现有的研究集中在潜在的机制上，包括酒精暗示的反应性，影响 监管和行为控制，但这些结构在很大程度上是使用自我报告措施进行测试的， 从神经认知的角度考察这些机制的研究也很少，这一点值得注意。 为了解决这一知识差距，拟议的研究将在多个层面上审查MOBC，包括自我 报告、行为表现和神经网络参与，重点关注侧和侧的功能 内侧额叶控制网络、基于纹状体的奖赏网络和支持情绪的杏仁核网络 反应性。180名患有AUD的寻求治疗的患者将被随机分成两组 接受认知行为治疗(CBT)或基于正念的治疗(MBT)后8周 为期数周的平台治疗，重点是增强变革的动力。要建立时间上的 饮酒变化与这些MOBC变化之间的关系，患者将在以下方面进行评估：(A) (B)治疗后4周；(C)治疗后立即；及(D)治疗后9个月和15个月- 基线。自我报告措施和行为任务将在治疗期间每月进行一次； 并在基线、基线后3个月和9个月收集功能磁共振成像。变化之间的关系 将使用先进的混合建模技术来研究建议的MOBC的变化 这是由研究团队率先提出的。此外，该项目将利用在一个单独的 在非处理寻求样本中使用与在类似的 时间点。通过确定CBT或MBT中对饮酒变化有不同贡献的MOBC， 提议的项目不仅将对成功的行为改变有更深的理解，而且还可能 告知澳大利亚糖尿病的新治疗方法的发展。此外，通过识别神经认知因素， 预测成功的变化，有可能利用这一知识将特定的治疗与 特定的患者神经认知特征。