Cognitive Remediation for Alcohol Use Disorder and Posttraumatic Stress Disorder

酒精使用障碍和创伤后应激障碍的认知治疗

• 批准号: 9379806
• 负责人: Adrienne Julie Heinz
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9379806
• 关键词: Address; Adherence; Adult; Affect; Aging; Alcohol consumption; Applications Grants; Attention; Behavior; Behavior Control; Behavioral Model; Brain; Chiroptera; Chronic; Clinical; Cognition; Cognitive; Cognitive remediation; Comorbidity; Complex; Comprehension; Counseling; Data; Diagnosis; Disease; Emotional; Ensure; Evaluation; Focus Groups; Fostering; Frequencies; Functional disorder; Goals; Group Interviews; Healthcare Systems; Home environment; Hour; Impaired cognition; Impairment; Individual; Informal Social Control; Institutes; Instruction; Intervention; Investigator-Initiated Research; Literature; Measures; Memory; Mental Health; Mental disorders; National Institute of Drug Abuse; Neurocognitive; Neuropsychology; Neurosciences; Online Systems; Outcome; Outpatients; Participant; Patients; Pattern; Performance; Placebos; Plasticizers; Policies; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prevalence; Problem Solving; Process; Prospective Studies; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Recovery of Function; Recruitment Activity; Rehabilitation therapy; Relapse; Research; Research Design; Risk; Risk Factors; Schizophrenia; Science; Self Management; Services; Severities; Substance Use Disorder; Substance abuse problem; Symptoms; Technology; Testing; Training; Training Programs; Transportation; Veterans; Vulnerable Populations; addiction; alcohol use disorder; base; clinical practice; cognitive function; cognitive process; cognitive recovery; cognitive training; computer game; computerized; cost; design; dual diagnosis; efficacy testing; evidence base; executive function; experience; follow-up; functional outcomes; health administration; high risk population; improved; indexing; innovation; patient oriented; patient population; primary outcome; programs; public health relevance; remediation; satisfaction; seal; secondary outcome; skills; therapy development; tool; translational research program; treatment program; usability

DESCRIPTION: The prevalence of Alcohol Use Disorder (AUD), Posttraumatic Stress Disorder (PTSD) and co-occurring AUD and PTSD is elevated among Veterans compared to civilians (Carter et al., 2011). Despite available empirically supported treatments, relapse and non-response rates remain high and individuals with co-occurring AUD and PTSD evidence particularly poor clinical and functional outcomes (McCarthy & Petrakis, 2010). Given recent estimates that 63-76% of OEF/OIF Veterans with an AUD also have a diagnosis of PTSD (Seal et al., 2011), there is urgent need to reduce chronic impairment among this growing and highly vulnerable population. AUD and PTSD are characterized by separate and overlapping deficits in attention, memory and higher-order skills known as executive functions (e.g., planning, inhibition, self-regulation), which are in turn, associated with poor clinical and functional outcomes (Bates et al., 2013; Polak et al., 2012, Aupperle, 2012). Indeed, cognitive dysfunction can interfere with many aspects of recovery (e.g. gaining control of maladaptive, over-trained behaviors) and its targeting as a trans-disease process for direct intervention represents a potentially high-yield and innovative approach for optimizing recovery outcomes. Neuroscience-based computerized cognitive training programs for psychiatric illness have achieved growing support in the literature and demonstrate strong potential to remediate disrupted cognitive processes observed in AUD and co- occurring PTSD (Bates et. 2013; Vinogradov et al., 2012). These programs offer a highly accessible, individualized, patient-driven, non-medication treatment approach for improving cognitive functioning. Such improvements may increase emotional and behavioral control and enhance patients' capacity to effectively employ more adaptive self-management strategies. To date however, no studies have capitalized on available evidence-based cognitive remediation technologies to comprehensively target patterns of neurocognitive dysfunction that underlie both AUD and PTSD. The proposed RR&D CDA-2 seeks to fill this gap by conducting a randomized prospective study, designed to evaluate the feasibility and efficacy of an existing web-based cognitive training program (BrainHQ; Posit Science/Brain Plasticity Institute) versus a placebo, for improving cognitive functioning and recovery outcomes. The research will be conducted iteratively, in two stages, based on the Stage Model of Behavioral Therapy Development per the National Institute on Drug Abuse, and has two overarching aims: Aim 1: Examine the acceptability, usability and feasibility of an existing web-based cognitive training program tailored for AUD and co-occurring PTSD. Aim 2: Test the efficacy of the web-based cognitive training program to improve cognitive functioning as well as clinical and functional outcomes. To test these aims, 148 Veterans with AUD and PTSD will be recruited from an outpatient Substance Use Disorder (SUD) treatment program. Participants will be randomized into either cognitive training or a computer game control. Individuals will then complete a baseline assessment, followed by 30 hours of home-based cognitive training or computer games over 6 weeks. Assessments will be completed each week of the training, as well as post-training and at post- training follow-up. Our primary outcome will be performance on an (untrained) neuropsychological assessment battery 6 months post-training. Secondary outcomes include alcohol use, PTSD symptoms and quality of life. Findings from the proposed study will inform clinical practice and policy by investigating whether a cognitive training program (shown to improve cognitive functioning in other clinical populations) can improve cognitive functioning and promote gains in functional recovery from AUD and PTSD. This study will lay the groundwork to investigate the potential for cognitive training to remediate neurocognitive disruptions in other dually diagnosed SUD patient populations across different VA treatment programs. This translational program of research will help vulnerable Veteran populations achieve more optimal and enduring recovery outcomes.

说明： 与平民相比，退伍军人中酒精使用障碍(AUD)、创伤后应激障碍(PTSD)以及共同发生的AUD和PTSD的患病率更高(Carter等人，2011年)。尽管有经验支持的治疗方法，但复发率和无反应率仍然很高，同时患有AUD和PTSD的患者的临床和功能结果尤其糟糕(McCarthy&Petrakis，2010)。鉴于最近估计63-76%患有AUD的OEF/OIF退伍军人也被诊断为创伤后应激障碍(Seal等人，2011年)，迫切需要减少这一不断增长的高度脆弱人群中的慢性损害。AUD和PTSD的特点是注意力、记忆和称为执行功能(如计划、抑制、自我调节)的高阶技能存在独立和重叠的缺陷， 这反过来又与不良的临床和功能结果相关(Bates等人，2013；Polak等人，2012，Aupperle，2012)。事实上，认知功能障碍可以干扰康复的许多方面(例如，获得对适应不良、过度训练的行为的控制)，将其作为直接干预的跨疾病过程的目标，是优化康复结果的一种潜在的高收益和创新的方法。以神经科学为基础的精神疾病计算机认知训练计划在文献中得到了越来越多的支持 并显示出强大的潜力来补救在AUD和共发生的PTSD中观察到的中断的认知过程(Bates et.2013年；Vinogradov等人，2012年)。这些计划提供了一种高度可及的、个性化的、以患者为导向的非药物治疗方法，以改善认知功能。这样的改进可能会增加情绪和行为控制，并增强患者有效地采用更适应的自我管理策略的能力。然而，到目前为止，还没有研究利用现有的循证认知补救技术来全面靶向AUD和PTSD的神经认知功能障碍模式。拟议的RR&D CDA-2旨在通过进行随机前瞻性研究来填补这一空白，该研究旨在评估现有基于网络的认知培训计划(BrainHQ；Positive Science/Brain Placity Institute)与安慰剂相比在改善认知功能和康复结果方面的可行性和有效性。这项研究将根据国家药物滥用研究所的行为治疗发展阶段模型，分两个阶段迭代进行，并有两个总体目标：目标1：检查现有的基于网络的认知培训计划的可接受性、可用性和可行性，该培训计划是为AUD和同时发生的PTSD量身定做的。目的2：测试基于网络的认知训练计划的有效性，以改善认知功能以及临床和功能结果。为了测试这些目标，148名患有AUD和PTSD的退伍军人将从门诊物质使用障碍(SUD)治疗计划中招募。参与者将被随机分为认知训练组或电脑游戏控制组。然后，个人将完成基线评估，然后在6周内进行30小时的家庭认知培训或电脑游戏。每周将完成培训评估，以及培训后和培训后后续行动。我们的主要结果将是在培训后6个月进行(未经训练的)神经心理评估组合的表现。次要结果包括饮酒、创伤后应激障碍症状和生活质量。这项拟议研究的结果将通过调查认知训练计划(被证明可以改善其他临床人群的认知功能)是否可以改善认知功能，并促进从AUD和PTSD中获得的功能恢复，为临床实践和政策提供参考。这项研究将为研究认知训练在不同VA治疗方案中修复其他双重诊断的SUD患者群体的神经认知障碍的可能性奠定基础。这一转化性研究计划将帮助脆弱的退伍军人实现更优化和更持久的恢复结果。