Efficacy and neural mediators of response to Trauma Management Therapy for PTSD

摘要 愤怒和攻击性是创伤后应激治疗中严重且常见的复杂因素 精神障碍(PTSD)。人际攻击和愤怒与创伤后应激障碍密切相关(Orth&Wiland， 2006年；Taft等人，2012年)；ii)与战斗有关的创伤后应激障碍患者特别有害(Novaco& Chemtob，2002年)；和，iii)战斗相关创伤后应激障碍的有效治疗的关键障碍(福布斯等人，2003年； 福布斯等人，2008年)。愤怒和攻击性也会严重损害人的人际关系 退伍军人；这些关系对于恢复功能所需的社会支持是必不可少的 (Beckham等人，1997；Carlson等人，2008；Elbogen等人，2008；Frueh等人，1997；2001；Chemtob等人， 1997年；Freeman&Roca，2001；Gerlock，1994；Glenn等人，2002；Lasko等人，1994；Taft等人，2005,2007 a； 2007年b；Monson&Taft出版社，2005年)。尽管愤怒和攻击性对 患有创伤后应激障碍的退伍军人，尽管愤怒和攻击性对治疗和 康复，对创伤后应激障碍中潜在的人际攻击的神经基础了解很少，或者 促进有愤怒和攻击性困难退伍军人康复的神经机制。 在之前的工作中，我们的团队开发了创伤管理疗法(TMT)，这是一种多组分 针对越南时期患有创伤后应激障碍的慢性退伍军人的心理治疗，同时针对恐惧和焦虑症状 如人际功能障碍(Frueh等人，1996；Bedel，Frueh等人，2011)。尽管这种疗法得到了支持 根据在越南时代的慢性退伍军人中进行的一项小型随机对照试验的结果，其疗效尚未在 从OEF/OIF/OND回来的更年轻、不那么慢性的退伍军人。在单独的工作中，我们已经确定 退伍军人的人际攻击、合作和情绪失调机制 与创伤后应激障碍(见初步数据；King-Casas&Chiu，2012；King-Casas等人，2005；朱等人，准备中； Lindsey等人，2010年)。然而，这些机制在治疗和康复中所起的作用尚不清楚。 在这里，我们建议利用这两条研究路线来(I)评估创伤处理的有效性 TMT治疗OEF/OIF/OND退伍军人创伤后应激障碍 与越战时期患有创伤后应激障碍的退伍军人相比，慢性病程，和(Ii)评估临床神经介质 与TMT相关的改进。

ABSTRACT Anger and aggression are serious and frequent complicating factors in the treatment of post-traumatic stress disorder (PTSD). Interpersonal aggression and anger are: i) strongly associated with PTSD (Orth & Wieland, 2006; Taft et al, 2012); ii) particularly pernicious among individuals with combat-related PTSD (Novaco & Chemtob, 2002); and, iii) critical barriers to effective treatment in combat-related PTSD (Forbes et al., 2003; Forbes et al., 2008). Anger and aggression can also critically damage the interpersonal relationships of veterans; these relationships are essential to the social support necessary for recovery of functioning (Beckham et al., 1997; Carlson et al., 2008; Elbogen et al., 2008; Frueh et al., 1997; 2001; Chemtob et al., 1997; Freeman & Roca, 2001; Gerlock, 1994; Glenn et al., 2002; Lasko et al., 1994; Taft et al., 2005, 2007a; 2007b; Monson & Taft, 2005). Despite the detrimental impact that anger and aggression have on the lives of combat veterans with PTSD, and despite the barrier that anger and aggression pose to treatment and recovery, very little is understood about the neural substrates underlying interpersonal aggression in PTSD, or the neural mechanisms that promote recovery for veterans with difficulties with anger and aggression. In previous work, our team has developed Trauma Management Therapy (TMT), a multicomponent psychotherapy for chronic, Vietnam-era veterans with PTSD targeting both fear and anxiety symptoms, as well as interpersonal dysfunction (Frueh et al., 1996; Beidel, Frueh et al., 2011). Though this treatment is supported by results of a small RCT among chronic Vietnam-era veterans, its efficacy has not been evaluated among younger, less chronic veterans returning from OEF/OIF/OND. In separate work, we have identified mechanisms of interpersonal aggression, cooperation, and emotional dysregulation in OEF/OIF/OND veterans with PTSD (see Preliminary Data; King-Casas & Chiu, 2012; King-Casas et al., 2005; Zhu et al., in preparation; Lindsey et al., 2010). However, the role that these mechanisms play in the treatment and recovery is unknown. Here, we propose to leverage these two lines of research to (i) evaluate the efficacy of Trauma Management Therapy (TMT) for the treatment of PTSD in OEF/OIF/OND veterans who are younger and have had a less chronic course of illness than Vietnam era veterans with PTSD, and (ii) evaluate neural mediators of clinical improvements associated with TMT.