Neural Mechanisms of a Novel Psychotherapy in Veterans with PTSD and Alcoholism

患有创伤后应激障碍和酗酒的退伍军人的新型心理治疗的神经机制

• 批准号: 9223646
• 负责人: ANDREA SPADONI TOWNSEND
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2018-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9223646
• 关键词: Affect; Affective; Afghanistan; Aftercare; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcoholism; Alcohols; Amygdaloid structure; Anterior; Biological Neural Networks; Brain; Caring; Clinical Practice Guideline; Cognitive Therapy; Comorbidity; Coping Skills; Corpus striatum structure; Cues; Development; Diagnosis; Disease; Disease remission; Drug Addiction; Drug abuse; Etiology; Exposure to; Functional Magnetic Resonance Imaging; Funding; Goals; Image; Incidence; Individual; Insula of Reil; Intervention; Intervention Studies; Iraq; Knowledge; Legal; Link; Maintenance; Measures; Medical; Mental disorders; Mission; Neurobiology; Nucleic Acid Regulatory Sequences; Outcome; Participant; Pathogenesis; Patients; Pattern; Play; Population; Post-Traumatic Stress Disorders; Prefrontal Cortex; Psychotherapy; Randomized Controlled Trials; Research; Rewards; Role; Safety; Severities; Social Problems; Stress; Structure; Substance Use Disorder; Symptoms; Treatment Efficacy; Treatment outcome; Veterans; Visual; alcohol abuse therapy; alcohol comorbidity; alcohol cue; alcohol intervention; alcohol use disorder; alternative treatment; base; blood oxygen level dependent; clinical practice; combat; compare effectiveness; cue reactivity; drinking; dual diagnosis; effective therapy; evidence base; functional outcomes; healing; imaging study; improved; improved outcome; incentive salience; negative affect; neural circuit; neural correlate; neurobiological mechanism; neuroimaging; neuromechanism; neuropsychiatric disorder; novel; psychologic; psychological outcomes; public health relevance; relating to nervous system; relative effectiveness; response; service member; therapeutic biomarker; tool; treatment effect; treatment response; treatment strategy; trial comparing; trial design

DESCRIPTION (provided by applicant): Rates of posttraumatic stress disorder (PTSD) are high among combat Veterans. Estimates of PTSD within Iraq and Afghanistan Veterans suggest that nearly 17% of active duty and over 24% of reserve service members screen positive for PTSD. Among individuals diagnosed with PTSD, the incidence of drug abuse and addiction is markedly elevated, with the highest comorbidity observed for alcohol use disorders, estimated to be as high as 85% in individuals seeking PTSD treatment. When these comorbidities manifest they result in poorer psychological, functional, and treatment outcomes than either disorder alone. Evidence suggests that neurobiological mechanisms, such as dysregulation of specific brain structures (e.g., amygdala, insula, prefrontal cortex, and striatum) appear to play crucial roles in the maintenance and remission of concurrent AD/PTSD. Currently there are no translational imaging studies that have examined whether patterns of brain activation can predict differences in treatment response in this population, and no attempts have been made to link psychotherapeutic interventions to neurobiological targets in AD/PTSD individuals. Therefore, the long- term goal of this line of research is to use neuroimaging tools to advance our ability to provide optimized, targeted interventions that support improved outcomes for Veterans with AD/PTSD. The objective of this proposal, which is a first step in pursuit of this goal, is to measure the brain response to an anticipatory task and an alcohol cue reactivity task before and after treatment for AD/PTSD in order to 1) delineate a neural profile of treatment responsiveness to empirically supported interventions, and 2) to compare the relative effects of an exposure based to a non-exposure based treatment on the neural substrates thought to maintain these disorders. Participants will receive one of two, 8-week-long, treatments within an ongoing, VA-funded, randomized controlled trial designed to compare the effectiveness of an exposure-based psychotherapy (i.e., Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE)) against the widely used psychotherapy, Seeking Safety (SS), that does not include exposure for the treatment of AD/PTSD. We hypothesize that baseline patterns of brain response will relate to the capacity to improve in the context of therapy, and that the sub-components of COPE and SS will differentially affect change in those neural circuits maintaining AD/PTSD.

描述(由申请人提供)： 在退伍军人中，创伤后应激障碍(PTSD)的发生率很高。对伊拉克和阿富汗退伍军人中创伤后应激障碍的估计表明，近17%的现役军人和超过24%的预备役军人对创伤后应激障碍筛查呈阳性。在被诊断为创伤后应激障碍的个人中，药物滥用和成瘾的发生率显著上升，其中酒精使用障碍的共患率最高，估计在寻求创伤后应激障碍治疗的个人中高达85%。当这些并存表现出来时，它们会导致比单独的任何一种障碍更差的心理、功能和治疗结果。有证据表明，神经生物学机制，如特定脑结构(如杏仁核、脑岛、前额叶皮质和纹状体)的失调，似乎在并发AD/PTSD的维持和缓解中发挥关键作用。目前，还没有翻译成像研究检验大脑激活模式是否可以预测这一人群中治疗反应的差异，也没有尝试将心理治疗干预与AD/PTSD患者的神经生物学靶点联系起来。因此，这一系列研究的长期目标是使用神经成像工具来提高我们的能力 提供优化的、有针对性的干预措施，支持改善患有AD/PTSD的退伍军人的结局。这项建议是实现这一目标的第一步，其目的是测量AD/PTSD治疗前后大脑对预期任务和酒精线索反应任务的反应，以便1)描绘治疗对经验支持的干预措施的神经反应，以及2)比较基于暴露的治疗和基于非暴露的治疗在被认为维持这些障碍的神经底物上的相对影响。参与者将在一项正在进行的、由退伍军人管理局资助的随机对照试验中接受两种为期8周的治疗之一，该试验旨在比较基于暴露的心理治疗(即，同时治疗PTSD和使用长期暴露的物质使用障碍(COP))与广泛使用的心理治疗--寻求安全(SS)--的有效性，后者不包括AD/PTSD的暴露治疗。我们假设，大脑反应的基线模式将与治疗背景下改善的能力有关，COPE和SS的亚成分将不同地影响维持AD/PTSD的神经回路的变化。