Cognitive Training as a Novel Neuroscience-based Treatment for PTSD

创伤后应激障碍(PTSD)是一种慢性致残性疾病，发生在 在经历创伤应激后的个人，这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。尽管存在针对创伤后应激障碍的循证心理社会治疗，但相当一部分人 对治疗没有完全的反应。因此，显然有必要继续研究新的干预措施。 退伍军人的创伤后应激障碍。最近，针对精神健康障碍的新干预措施已经使用了计算机 认知训练技术，以改善认知系统的功能，减轻症状。 这种类型的干预，通常被称为神经治疗学，可能会让创伤后应激障碍成为一种治疗 改善症状，提高认知能力。创伤后应激障碍患者表现出认知障碍 控制功能，似乎与疾病的症状有因果关系(例如，侵入性创伤- 相关记忆)。到目前为止，神经疗法在退伍军人中对创伤后应激障碍的疗效研究还不够深入。 目前的建议旨在将创伤后应激障碍的基本神经认知机制的研究与 认知控制训练随机对照试验(RCT)干预研究 对80名患有创伤后应激障碍的退伍军人进行治疗。退伍军人将完成设计的计算机训练演习 具体针对和改进认知控制的各个方面。退伍军人将完成两次计划 每周一次，持续八周。症状将在治疗前和治疗后进行评估，以及在两次- 月随访时间点。这项研究的主要目标是检查干预措施对 创伤后应激障碍症状和认知缺陷。评估作为干预结果的症状变化将 提供有关该计划作为创伤后应激障碍治疗的效用的关键数据。如果有效，这种培训 该计划可以作为患有创伤后应激障碍的退伍军人的替代治疗选择，并可以转化为 便于传播的干预措施(例如，通过基于网络的平台)。次要的 目标是使用功能磁共振成像(FMRI)通过以下方式更好地了解机制 而认知训练最终会减少症状。如果用来训练认知控制 神经疗法如假设的那样直接增强特定神经底物的功能， 依赖于共享神经区域的情感过程的改善也是可以预测的。正在修改 因此，在这些底物上进行训练可以通过改善神经功能来减少症状。 同时处理和管理与创伤相关的情感和信息。用于认知的神经系统 还招募了在所描述的训练中作为目标的对照(例如，背外侧前额叶皮质[dlPFC]) 当个体在精神上操纵情绪信息时，例如当个体使用重新评估来 改变他们看待负面情绪情况或内容的方式。在这项研究中，退伍军人将 完成中性认知控制任务和再评价任务，同时在前后进行fMRI检查 完成训练治疗。这将是第一个评估神经生物学机制的研究。 创伤后应激障碍的这种类型的培训，这是理解如何改善 培训计划，以及完成培训计划可能对谁最有利。 根据申请人先前在临床试验和认知训练研究方面的经验， 拟议的培训计划为神经心理学的新实践培训提供了机会， 认知康复和功能神经成像技术，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，将 神经生物学工具与干预研究，并为成功准备提供关键的试点数据 退伍军人荣誉奖获得者。总之，研究和培训计划将使申请者做好准备 在退伍军人制度中过渡到独立的临床科学家角色。

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.