Project IMPACT: In-the-Moment Protection from Automatic Capture by Triggers

项目影响：通过触发器自动捕获的即时保护

• 批准号: 9203038
• 负责人: MARSHA E. BATES
• 金额: $ 53.8万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-20 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9203038
• 关键词: Abstinence; Address; Affect; Affective; Aftercare; Alcohol consumption; Alcohols; Anxiety; Arousal; Attention; Baroreflex; Behavior Control; Behavior Therapy; Behavioral; Behavioral Mechanisms; Biofeedback; Biological; Biological Process; Blood Vessels; Brain; Breathing; Cardiac; Cellular Phone; Child; Client; Clinical Research; Cognitive; Communication; Communities; Computer Simulation; Conscious; Cues; Data; Desire for food; Disease; Drug usage; Electrocardiogram; Emotions; Functional Magnetic Resonance Imaging; Generations; Genetic; Goals; Health; Heart; Individual; Intervention; Knowledge; Laboratories; Lead; Life; Link; Mediating; Mental Depression; Modeling; Mothers; Myocardium; Neurobiology; Outcome; Outpatients; Participant; Pattern; Persons; Pharmaceutical Preparations; Physiological; Physiology; Placebos; Population; Process; Public Health; Randomized; Randomized Clinical Trials; Reaction; Recovery; Relapse; Research; Research Support; Role; Sampling; Signal Transduction; Specific qualifier value; Stress; System; Techniques; Testing; Time; Training; Translating; Translational Research; Trauma; Treatment outcome; Visceral; Woman; addiction; alcohol abuse therapy; alcohol and other drug; alcohol use disorder; base; behavior change; biobehavior; biological systems; cognitive control; cognitive enhancement; cognitive function; craving; drinking; drinking behavior; emotion regulation; experimental study; flexibility; heart rate variability; improved; negative affect; novel strategies; operation; person centered; post intervention; predictive modeling; public health relevance; relating to nervous system; response; therapy design; treatment as usual; treatment program

DESCRIPTION (provided by applicant): There are effective behavioral interventions to treat alcohol use disorders, but over time, treatment gains are often lost when clients find themselves unable to resist drinking because of negative emotions and appetitive cues. The power of internal and environmental "triggers" to elicit relapse, even among clients with conscious abstinence goals and extended abstinence, is compelling and well-documented. Thus, bolstering clients' ability to withstand drinking triggers and craving in real time could have tremendous public health impact. This application proposes translational research that focuses on the a priori defined and malleable baroreflex (BAR) mechanism. The BAR is a dynamic mechanism that helps to regulate automatic-visceral reactivity to triggers of alcohol and other drug use by regulating bidirectional communication between the heart and brain. A key feature of the BAR mechanism is that it can be consciously manipulated using a simple behavioral breathing technique called resonance breathing. This manipulation can occur "in the moment" and outside of the treatment context as triggers are anticipated or encountered. This application proposes a randomized clinical trial of a BAR-based intervention (added to behavioral treatment as usual) in conjunction with laboratory assessments (pre-post intervention design), and computational modeling to validate the operation of the BAR as a biobehavioral change mechanism. The sample comprises women with young children from an empirically supported, intensive outpatient behavioral treatment program (IOP). The intervention involves daily use of iPhone applications (apps) during IOP treatment weeks 4-12. Those randomized to the active intervention will be trained to use an existing resonance breathing app to activate the BAR mechanism as they anticipate or confront emotions or cues that can trigger relapse. Participants in the placebo group will use an app that does not affect the BAR. Aim 1 will address whether activating the BAR mechanism accelerates and stabilizes positive behavior change, specifically change in alcohol and drug use, anxiety, craving, depression during and after treatment. Aim 2 will compare natural versus manipulated changes in BAR functioning pre- to post- intervention using physiological, and, for a subset of women, fMRI data to correlate biological and behavioral change. Aim 3 will characterize how and for whom the BAR mechanism supports behavior change using computational modeling to capture change across multiple interacting biological systems within a person. The novelty of this study comes from focusing on a well-specified automatic-physiological mechanism, capturing change in the dynamic space of "real life" replete with triggers and affective changes, characterizing the BAR mechanism across biobehavioral levels using variable-and person-centered quantitative strategies, and focusing on an understudied population whose positive behavior change can have important immediate and long-term health implications. If successful, the proposed research will set the stage for a new generation of mechanism-based intervention approaches and personalized prognostic models.

描述（由申请人提供）：有有效的行为干预来治疗酒精使用障碍，但随着时间的推移，当客户发现自己由于负面情绪和食欲暗示而无法抵抗饮酒时，治疗效果往往会失去。内部和环境“触发因素”诱发复发的力量是令人信服的，并且有充分的证据证明，即使在有有意识的禁欲目标和长期禁欲的客户中也是如此。因此，提高客户实时抵御饮酒诱因和渴望的能力可能会对公共卫生产生巨大影响。该应用程序提出了翻译研究，重点是先验定义和可延展的压力反射（BAR）机制。BAR是一种动态机制，通过调节心脏和大脑之间的双向交流，帮助调节酒精和其他药物使用触发的自动内脏反应。BAR机制的一个关键特征是，它可以有意识地使用一种简单的称为共振呼吸的行为呼吸技术来操纵。当预期或遇到触发器时，这种操作可以“在当下”发生，也可以在治疗上下文之外发生。本申请提出了一项基于BAR干预的随机临床试验（像往常一样加入行为治疗），结合实验室评估（干预前-后设计）和计算建模来验证BAR作为生物行为改变机制的运作。样本包括有幼儿的妇女从经验支持，强化门诊行为治疗方案（IOP）。干预包括在IOP治疗4-12周期间每天使用iPhone应用程序。那些被随机分配到积极干预组的人将接受训练，在他们预测或面对可能引发复发的情绪或线索时，使用现有的共振呼吸应用程序来激活BAR机制。安慰剂组的参与者将使用不影响BAR的应用程序。目的1将探讨激活BAR机制是否会加速和稳定积极的行为改变，特别是在治疗期间和治疗后对酒精和药物使用、焦虑、渴望、抑郁的改变。目的2将比较干预前后BAR功能的自然变化和人为变化，使用生理数据，对于一部分女性，使用功能磁共振成像数据来关联生物学和行为变化。目标3将描述BAR机制如何以及为谁支持行为改变，使用计算建模来捕获人体内多个相互作用的生物系统的变化。本研究的新颖之处在于关注一个明确的自动生理机制，捕捉充满触发因素和情感变化的“现实生活”动态空间中的变化，使用变量和以人为中心的定量策略描述跨生物行为水平的BAR机制，并关注未充分研究的人群，这些人群的积极行为改变可能对健康产生重要的即时和长期影响。如果成功，这项研究将为新一代基于机制的干预方法和个性化预后模型奠定基础。