Augmenting cognitive behavioral therapy with inhibitory control training

项目总结 大量研究表明，抑制性控制的缺陷，即抑制、延迟或 中断自动响应是大范围奖励性不适应的关键维持因素 暴饮暴食、大便、自残、滥用药物等行为。虽然许多患有这些疾病的患者 行为受益于认知行为疗法(CBT)，一大部分患者的体验不佳 结果，可能是因为CBT不直接针对抑制性控制。因此，人们对此越来越感兴趣 抑制性控制训练(信息通信技术；即提示参与者重复执行计算机任务 抑制对相关刺激的按键反应)可以在抑制控制中产生改进，并且是 对CBT进行了有用的增强。现有数据表明，信通技术可以在抑制控制方面产生变化 行为和神经回路水平(靶参与)，抑制控制的改善可以 减少基于实验室的行为或短期行为(目标验证)。然而，关于ICT能力的调查结果 在实验室外产生持续的行为变化仍然是喜忧参半且有限的。然而， 对信息和通信技术的调查：(1)在持续的一段时间内利用重复、密集的培训；(2)具有适应性 对个人的表现；和(3)对个人行为的个性化，没有进行过。 此外，我们对病情的了解不足(例如，在临床样本中，主持人 答复)，在哪些情况下信通技术是有效的。因此，靶子试验有很强的科学前提。 重复、个性化的信息和通信技术的参与度、验证和初步效果。而信息通信技术可能会有所改善 一系列疾病的结局，暴饮暴食的患者(即大量进食的发作 在有失控感的离散时间段内)，特别是那些被诊断为神经性暴食症的人 (BN)和暴饮暴食障碍(BED)非常适合作为CBT的辅助工具进行ICT测试。我们将评估 个性化、重复的计算机化ICT是否可以改善CBT的抑制性控制和结果 BN和床。我们将对有BN(n=40)和Bed(n=40；总计n=80)的个人进行随机分配，让他们每天在- 在CBT的前四周内，家庭辅助ICT或虚假的训练条件。我们的主要目标包括： (1)确认目标投入，即ICT在抑制控制方面产生改进；(2)测试 假设与CBT相比，CBT ICT将在暴饮暴食频率方面产生更大的改善 Sham和(3)检验抑制控制的改善将与以下变化相关的假设 暴饮暴食(即目标验证)。我们的次要目标包括：(1)检验信息和通信技术的影响的假设 对于基线抑制性控制水平较差的个体，暴饮暴食的频率最高， 更倾向于食用美味的食物，以及更高的饮食限制；(2)测试可行性和 暴饮暴食患者重复ICT方案的可接受性，以告知全面有效性 RCT。作为一个探索性目标，我们将检查诊断(BN或BED)是否会调节ICT的效果。

PROJECT SUMMARY A large body of research demonstrates that deficits in inhibitory control, i.e., the ability to withhold, delay, or interrupt an automatic response, are a crucial maintaining factor for a large swath of rewarding maladaptive behaviors, such as binge eating, purging, self-injury, and substance abuse. While many patients with these behaviors benefit from cognitive behavioral therapies (CBTs), a large subset of patients experience suboptimal outcomes, likely because CBTs do not target directly inhibitory control. As such, there is growing interest whether inhibitory control trainings (ICTs; i.e., computer tasks in which participants are prompted to repeatedly withhold keypress responses to relevant stimuli) can produce improvements in inhibitory control and be a useful augmentation to CBT. Available data suggest that ICTs can produce changes in inhibitory control on the behavioral and neural circuitry levels (target engagement), and that improvements in inhibitory control can produce decreases in lab-based or short-term behavior (target validation). Yet, findings regarding ICT’s ability to produce sustained changes in behavior outside the laboratory remain mixed and limited. However, investigations of ICT that (1) utilize repeated, intensive trainings over a sustained time period; (2) are adaptive to an individual’s performance; and (3) are personalized to an individual’s behavior, have not been conducted. Additionally, we have insufficient understanding of the conditions (e.g., in clinical samples, moderators of response) under which ICTs are effective. As such, there is strong scientific premise for a test of target engagement, validation, and initial efficacy of a repeated, personalized ICT. While ICTs may improve outcomes for a number of disorders, patients with binge eating (i.e., episodes of eating large amounts of food in a discrete time period with a sense of loss of control), specifically those with a diagnosis of bulimia nervosa (BN) and binge eating disorder (BED), are well-suited for a test of ICT as an adjunct to CBT. We will evaluate whether a personalized, repeated computerized ICT can improve inhibitory control and outcomes from CBT for BN and BED. We will randomize individuals with BN (n=40) and BED (n=40; total n=80) to receive a daily, at- home adjunctive ICT or a sham training condition during the first four weeks of CBT. Our primary aims include: (1) Confirm target engagement, i.e., that ICT produces improvements in inhibitory control; (2) Test the hypothesis that CBT+ICT will produce greater improvements in binge eating frequency compared to CBT + sham and (3) Test the hypothesis that improvements in inhibitory control will be associated with changes in binge eating (i.e., target validation). Our secondary aims include: (1) Test the hypothesis that the effect of ICT on binge eating frequency will be strongest for individuals with poorer baseline levels of inhibitory control, greater approach tendencies to highly palatable food, and higher dietary restraint; (2) Test the feasibility and acceptability of a repeated ICT protocol in individuals with binge eating to inform a full-scale effectiveness RCT. As an exploratory aim, we will examine whether diagnosis (BN or BED) moderates the effect of ICT.