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

描述(申请人提供)：有有效的行为干预措施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抗拒饮酒时，治疗成果往往会丢失。内部和环境“诱因”引发复发的力量是令人信服的，而且有充分的证据证明，即使是在有意识的禁欲目标和长期禁欲的客户中也是如此。因此，增强客户实时承受饮酒触发和渴望的能力可能会对公共健康产生巨大影响。这项申请提出了翻译研究，重点放在先验定义的和可伸缩的压力反射(BAR)机制上。BAR是一种动态机制，通过调节心脏和大脑之间的双向通讯，帮助调节对酒精和其他药物使用的自动内脏反应。杆机构的一个关键特征是，它可以通过一种名为共振呼吸的简单行为呼吸技术有意识地进行操纵。当预期或遇到触发因素时，这种操作可能发生在治疗环境之外的“瞬间”。本申请提出了一项基于BAR的干预(通常添加到行为治疗中)与实验室评估(干预前和干预后设计)相结合的随机临床试验，并建立计算模型，以验证BAR作为生物行为改变机制的操作。样本包括来自经验性支持的强化门诊行为治疗计划(IOP)的有年幼孩子的妇女。干预包括在眼压治疗4-12周期间每天使用iPhone应用程序(APP)。那些随机接受积极干预的人将接受培训，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酒吧机制。安慰剂组的参与者将使用一款不影响酒吧的应用程序。目标1将解决激活BAR机制是否加速和稳定积极的行为变化，特别是在治疗过程中和治疗后酒精和药物使用、焦虑、渴望、抑郁的变化。目标2将使用生理学数据比较干预前后酒吧功能的自然变化和人为变化，并对一组女性使用fMRI数据来关联生物和行为变化。目标3将描述BAR机制如何以及为谁支持行为变化，使用计算建模来捕捉人体内多个相互作用的生物系统的变化。这项研究的新颖性来自于关注一种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，使用以变量和以人为中心的量化策略描述跨越生物行为水平的栏机制，并关注那些积极行为变化可能具有重要的即时和长期健康影响的未被研究的人群。如果成功，这项拟议的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。

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.