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

摘要 愤怒和攻击是严重的和经常复杂的因素在治疗创伤后应激反应 PTSD（PTSD）。人际攻击和愤怒：i）与PTSD密切相关（Orth & Wieland， 2006;塔夫脱等人，2012）; ii）在具有战斗相关PTSD的个体中特别有害（Novaco & Chemtob，2002）;和iii）有效治疗与战斗有关的PTSD的关键障碍（福布斯等人，二○ ○三年; 福布斯等人，2008年）。愤怒和攻击性也会严重破坏人际关系， 退伍军人;这些关系对于恢复功能所需的社会支持至关重要 （Beckham等人，1997; Carlson等人，2008; Elbogen等人，2008; Frueh等人，1997; 2001; Chemtob等人， 1997; Freeman和Roca，2001; Gerlock，1994; Glenn等人，2002; Lasko等人，1994;塔夫脱等人，2005年、2007年a; 2007 b;蒙森和塔夫脱，2005）。尽管愤怒和侵略对人们的生活产生了有害的影响， 与患有创伤后应激障碍的退伍军人作战，尽管愤怒和攻击性对治疗构成障碍， 恢复，很少有人了解PTSD中人际攻击的神经基质，或者 神经机制，促进退伍军人与愤怒和侵略困难的恢复。 在以前的工作中，我们的团队已经开发了创伤管理疗法（TMT），一种多组分的治疗方法。 心理治疗慢性，越南时代的退伍军人与创伤后应激障碍针对恐惧和焦虑症状，以及 作为人际功能障碍（Frueh等人，1996; Beidel，Frueh等人，2011年）。虽然这种治疗方法得到了 根据一项在长期越战老兵中进行的小型RCT的结果， 从持久自由行动/法语国家组织/刚果民主共和国观察团返回的年轻、慢性病较少的退伍军人。在单独的工作中，我们发现 OEF/OIF/OND退伍军人的人际攻击、合作和情绪失调机制 患有PTSD（参见Preliminary Data; King-Casas & Chiu，2012; King-Casas等人，2005; Zhu等人，筹备中; Lindsey等人，2010年）。然而，这些机制在治疗和恢复中的作用尚不清楚。 在这里，我们建议利用这两条线的研究，以（i）评估创伤管理的疗效 治疗OEF/OIF/OND退伍军人中PTSD的TMT，这些退伍军人年龄较小， 慢性病程比越南时代退伍军人与创伤后应激障碍，（ii）评估神经介质的临床 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.