Understanding and testing recovery processes for PTSD and alcohol use following sexual assault

项目摘要 在性侵犯之后，许多人会发展出慢性问题，包括创伤后压力。 创伤后应激障碍（PTSD）和酒精使用障碍（AUD）。攻击后立即提供的干预可以减少 发展慢性精神病理学的风险和相关的负面后果。干预措施， 创伤后应激障碍和酒精使用的共同潜在机制，如恐惧和奖励系统， 作为临床医生治疗近期暴露于 性侵这个提议旨在测试恐惧和奖励作为恢复的关键过程 并阐明最有效的治疗目标。使用实验任务 （安全信号学习范例和概率奖励任务），以捕获 恐惧和奖励系统将分别允许探索这些过程如何影响恢复。一 将进行一项随机临床试验（N = 180），以测试干预方法的有效性， PTSD或酒精使用与支持性远程医疗的比较。此外，分阶段研究设计将允许 探索初级和二级干预方法的有效性，以测试以下问题：1）是否 首先针对PTSD或酒精使用更有效; 2）是否有必要针对PTSD和 使用酒精以促进恢复或如果一个是足够的。这一建议对探索转诊断具有重要意义 在性侵犯、恐惧和奖励后的恢复中涉及的机制，并使用一种新的设计， 比较两种不同干预方法的有效性、顺序和必要性。

PROJECT SUMMARY Following sexual assault, many individuals will develop chronic problems including posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD). Intervention provided soon after assault can decrease the risk of developing chronic psychopathology and associated negative consequences. Interventions that address common underlying mechanisms of PTSD and alcohol use, such as fear and reward systems, have strong potential utility as efficacious and accessible interventions for clinicians treating patients recently exposed to sexual assault. This proposal is designed to test fear and reward as crucial processes underlying recovery following sexual assault and elucidate the most efficacious treatment targets. Employing experimental tasks (safety-signal learning paradigm and probabilistic reward task) to capture baseline underlying vulnerabilities in fear and reward systems respectively will allow for exploration of how these processes impact recovery. A randomized clinical trial (N = 180) will be conducted to test efficacy of intervention approaches that target PTSD or alcohol use compared to supportive telehealth. In addition, a phased study design will allow for exploration of efficacy of primary and secondary intervention approaches to test the questions of 1) whether it is more efficacious to target PTSD or alcohol use first; and 2) whether it is necessary to target both PTSD and alcohol use to facilitate recovery or if one is sufficient. This proposal is significant in exploring transdiagnostic mechanisms implicated in recovery following sexual assault, fear and reward, and using a novel design to compare efficacy, ordering, and necessity of two distinct intervention approaches.