Cognitive Training as a Novel Neuroscience-based Treatment for PTSD

认知训练作为一种基于神经科学的新型创伤后应激障碍治疗方法

• 批准号: 10295186
• 负责人: Jessica Bomyea
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10295186
• 关键词: Affect; Affective; Affective Symptoms; Aftercare; Anterior; Award; Brain; Chronic; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Coupled; Data; Development; Diagnostic; Disease; Disease model; E-learning; Educational Intervention; Emotional; Emotions; Etiology; Exercise; Functional Magnetic Resonance Imaging; Goals; Gold; Individual; Intervention; Intervention Studies; Interview; Learning; Measures; Memory; Mental Health; Mental disorders; Mentors; Methods; Modification; Neurobehavioral Manifestations; Neurobiology; Neurocognitive; Neurophysiology - biologic function; Neuropsychology; Neurosciences; Online Systems; Participant; Pattern; Performance; Physiological; Post-Traumatic Stress Disorders; Prediction of Response to Therapy; Prefrontal Cortex; Preparation; Process; Psyche structure; Randomized Controlled Trials; Research; Research Personnel; Research Training; Role; Scientist; Secondary to; Services; Short-Term Memory; Subgroup; Symptoms; System; Techniques; Thinking; Time; Training; Training Programs; Training Technics; Translating; Trauma; Veterans; Woman; alternative treatment; base; cognitive control; cognitive enhancement; cognitive rehabilitation; cognitive system; cognitive training; computerized; design; effective therapy; effectiveness study; emotional symptom; evidence base; executive function; experience; follow-up; improved; improved functioning; intervention effect; intervention program; neurobiological mechanism; neuroimaging; novel; primary outcome; programs; psychosocial; recruit; reduce symptoms; relating to nervous system; sexual assault; skills; symptom treatment; symptomatic improvement; therapy development; tool; traumatic stress; treatment response; trial design

Posttraumatic stress disorder (PTSD) is a chronic, disabling condition that occurs in a subgroup of individuals after experiencing traumatic stress, and is common in Veterans seeking mental health treatment at the VA. Although evidence-based psychosocial treatments exist for PTSD, a substantial portion of individuals do not fully respond to treatment. Thus, there is a clear need to continue researching novel interventions for PTSD in Veterans. Recently, new interventions for mental health disorders have utilized computerized cognitive training techniques in order to improve the functioning of cognitive systems and reduce symptoms. This type of intervention, often referred to as neurotherapeutics, may hold promise for PTSD as a method for ameliorating symptoms and improving cognition. Individuals with PTSD demonstrate difficulties with cognitive control functions, which appear to be causally implicated in symptoms of the disorder (e.g., intrusive trauma- related memories). To date the efficacy of neurotherapeutics for PTSD has been understudied in Veterans. The current proposal aims to bridge research on basic neurocognitive mechanisms of PTSD with intervention research by conducting a randomized controlled trial (RCT) of a cognitive control training program in 80 Veterans with PTSD. Veterans will complete computer-based training exercises designed to specifically target and improve aspects of cognitive control. Veterans will complete the program twice per week for eight weeks. Symptoms will be assessed before and after treatment, as well as at a two- month follow up time point. The primary goal of the study is to examine the effect of the intervention on PTSD symptoms and cognitive deficits. Evaluating symptom change as a result of the intervention will provide critical data regarding the utility of this program as a PTSD treatment. If effective, this training program could serve as alternative treatment option for Veterans with PTSD, and could be translated into an easily transportable intervention for dissemination (e.g., through web-based platforms). A secondary goal is to use functional magnetic resonance imaging (fMRI) to better understand the mechanisms by which cognitive training culminates in symptom reduction. If training cognitive control with neurotherapeutics directly enhances functioning of specific neural substrates as hypothesized, improvements in affective processes relying on shared neural regions would also be predicted. Modifying functioning in these substrates with training may thus reduce symptoms by improving neural functioning while processing and managing trauma-related affect and information. Neural systems used for cognitive control targeted in the training described (e.g., dorsolateral prefrontal cortex [dlPFC]) are also recruited when individuals mentally manipulate emotional information, such as when individuals use reappraisal to change the way that they think about negative emotional situations or content. In this study, Veterans will complete a neutral cognitive control task and a reappraisal task while undergoing fMRI before and after completing the training treatment. This will be the first study to evaluate neurobiological mechanisms of this type of training in PTSD, which is a fundamental next step for understanding how to improve the training program and who may be best served by completing it. Building upon the applicant's prior experience with clinical trials and cognitive training research, the proposed training plan provides an opportunity for new hands-on training in neuropsychology, cognitive rehabilitation, and functional neuroimaging techniques to meet the immediate goal of developing skills in these domains. Long term, the award will facilitate development of expertise with integration of neurobiological tools with intervention research, and provide critical pilot data for successful preparation of a VA Merit Award. Together, the research and training plan will make the applicant well-poised to transition to an independent clinical scientist role within the VA system.

创伤后应激障碍（PTSD）是一种慢性致残性疾病，发生在一个亚组， 在经历创伤性应激反应后的个体，在寻求心理健康治疗的退伍军人中很常见， 退伍军人事务部尽管针对创伤后应激障碍存在循证心理社会治疗，但很大一部分人 对治疗没有完全反应。因此，显然需要继续研究新的干预措施， 退伍军人的PTSD最近，针对精神健康障碍的新干预措施利用了计算机 认知训练技术，以改善认知系统的功能和减少症状。 这种类型的干预，通常被称为神经疗法，可能有希望为创伤后应激障碍作为一种方法， 改善症状和提高认知。PTSD患者表现出认知障碍 控制功能，其似乎与疾病的症状有因果关系（例如，侵入性创伤- 相关记忆）。迄今为止，神经疗法对创伤后应激障碍的疗效在退伍军人中尚未得到充分研究。 目前的提案旨在将PTSD的基本神经认知机制的研究与 通过进行认知控制训练的随机对照试验（RCT）进行干预研究 80名患有PTSD的退伍军人退伍军人将完成基于计算机的训练演习， 专门针对和改善认知控制方面。退伍军人将完成该计划两次 每周8周。在治疗前和治疗后，以及在两个- 月随访时间点。这项研究的主要目的是检查干预措施对 创伤后应激障碍症状和认知缺陷评估干预导致的症状变化将 提供关于该计划作为PTSD治疗的实用性的关键数据。如果有效的话， 该计划可以作为创伤后应激障碍退伍军人的替代治疗选择，并可以转化为 易于运输的用于传播的干预（例如，通过网络平台）。次级 我们的目标是使用功能性磁共振成像（fMRI），以更好地了解机制， 认知训练最终会减轻症状如果训练认知控制， 神经治疗剂如所假设的那样直接增强特定神经基质的功能， 依赖于共享神经区域的情感过程的改善也将被预测。修改 因此，通过训练在这些基质中发挥作用可以通过改善神经功能来减轻症状 同时处理和管理创伤相关的影响和信息。用于认知的神经系统 所述训练中的目标控制（例如，背外侧前额叶皮层[dlPFC]）也被招募 当个体在心理上操纵情感信息时，例如当个体使用重新评价来 改变他们对负面情绪情况或内容的看法。在这项研究中，退伍军人将 完成中性认知控制任务和重新评价任务，同时接受fMRI前后 完成训练治疗。这将是第一项评估神经生物学机制的研究 这种类型的创伤后应激障碍的培训，这是了解如何改善 培训计划，以及谁可以通过完成它得到最好的服务。 基于申请人先前在临床试验和认知训练研究方面的经验， 所提出的培训计划为神经心理学中的新的实践培训提供了机会， 认知康复和功能性神经成像技术，以满足发展的直接目标， 这些领域的技能。从长远来看，该奖项将促进专业知识的发展， 神经生物学工具与干预研究，并提供关键的试点数据，为成功的准备 退伍军人事务部优秀奖总之，研究和培训计划将使申请人做好准备， 过渡到VA系统内的独立临床科学家角色。