A Randomized Controlled Trial of Cognitive Control Training for Urgency in a Naturalistic Clinical Setting

自然临床环境中紧急认知控制训练的随机对照试验

• 批准号: 9463259
• 负责人: Andrew D Peckham
• 金额: $ 5.63万
• 依托单位: MCLEAN HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-01 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9463259
• 关键词: Acute; Address; Adult; Alcohol or Other Drugs use; Anterior; Auditory; Behavior; Behavioral; Binge Eating; Biological; Brain; Brain region; Clinical; Cognitive; Cognitive deficits; Conflict (Psychology); Control Groups; Day Care; Detection; Dimensions; Disease; Educational Intervention; Electrophysiology (science); Emotions; Enrollment; Evaluation; Event-Related Potentials; Exercise; Goals; Impulsivity; Individual; Intervention; Link; Measures; Mental Depression; Mental Health; Mental disorders; Mentors; Mentorship; Meta-Analysis; Methodology; Mind; National Institute of Mental Health; Outcome; Participant; Patient Self-Report; Patients; Prefrontal Cortex; Preparation; Protocols documentation; Psychopathology; Randomized; Randomized Controlled Trials; Recruitment Activity; Reflex action; Reporting; Research; Sampling; Self-Injurious Behavior; Short-Term Memory; Signal Transduction; Step Tests; Suicide; Suicide attempt; Surveys; Symptoms; Techniques; Testing; Time; Training; Training Programs; Translating; Translations; Work; acute symptom; base; behavior measurement; behavior test; behavioral response; cingulate cortex; cognitive control; cognitive training; computerized; craving; density; emotion dysregulation; experience; injured; negative affect; novel strategies; programs; prospective; reduce symptoms; relating to nervous system; response; satisfaction; severe mental illness; source localization; successful intervention; trait; treatment as usual; treatment program; treatment response

Project Summary/Abstract Impulsivity is a common and significant predictor of destructive, maladaptive behaviors among people with mental illness. Research shows that one specific type of impulsivity, known as urgency, is particularly problematic. This type of impulsivity refers to reflexive responses to strong emotions. As emotion dysregulation is a well-established transdiagnostic feature of mental illness, the construct of urgency represents a “perfect storm” of both reactivity to emotion and impulsive action. Elevations in this form of impulsivity predict serious negative outcomes including self-injury, suicide attempts, and poor response to treatment. Despite these dire consequences, there are no specific, targeted treatments for urgency. However, the mechanisms that might influence the expression of this trait are beginning to be understood. Urgency is related to several cognitive deficits, including difficulty stopping a planned behavior (response inhibition) as well as difficulty storing and manipulating information in mind for short periods of time (working memory). Recent findings suggest that people who completed computerized exercises involving response inhibition and working memory showed significantly reduced levels of urgency after two weeks of treatment. However, it is unknown if this improvement would be observable among individuals with serious mental illness, or whether this type of training actually produces changes in the putative underlying brain regions that support response inhibition and working memory. In this study, we will recruit adult patients reporting high levels of urgency who are receiving treatment for acute symptoms of mental illness in an intensive Partial Hospitalization Program. Patients will be randomly assigned to receive treatment as usual (TAU) or to receive TAU augmented with a two-week computerized cognitive training program targeting response inhibition and working memory. All participants will undergo electrophysiological recording of brain activity (EEG) at baseline and upon discharge from the program, in order to test changes in brain activity relevant to response inhibition and working memory. The goals of this project are to (1) confirm that the cognitive training intervention successfully engages underlying brain mechanisms; (2) test whether this training is associated with greater clinical improvements in depression, urges to self-injure, or urges to use substances; and (3) assess feasibility and acceptability to patients using this intervention in a naturalistic setting. If successful, this study may provide evidence that this new approach to treating impulsivity effectively engages underlying biological mechanisms, is clinically efficacious, and is applicable to real-world clinical settings. These goals are highly consistent with the NIMH's Third Strategic Aim, which states that “The challenge is to test…potential mechanisms rapidly to rule in or rule out the target as a mechanism of the illness. This requires that the intervention engage the target and test its efficacy for reducing symptoms.” The present study embraces this challenge to rapidly test a treatment targeting cognitive mechanism underlying a trait with serious consequences for mental health.

项目总结/摘要 冲动是一种常见的和重要的预测破坏性，适应不良行为的人， 精神疾病研究表明，一种特殊类型的冲动，被称为紧迫感，特别是 有问题这种类型的冲动是指对强烈情绪的反射性反应。情绪失调 是精神疾病的一个公认的跨诊断特征，紧迫感的结构代表了一个“完美的” 情绪反应和冲动行为的“风暴”。这种形式的冲动预示着严重的 负面结果包括自伤、自杀企图和对治疗反应不佳。尽管这些可怕的 因此，没有具体的、针对性的紧急治疗方法。然而，可能 影响这一特征的表达开始被理解。紧迫感与几种认知有关 缺陷，包括难以停止计划的行为（反应抑制）以及难以储存和 在短时间内操纵头脑中的信息（工作记忆）。最近的研究结果表明， 那些完成了包括反应抑制和工作记忆在内的计算机化练习的人显示， 治疗两周后，尿急程度显著降低。然而，目前尚不清楚， 在患有严重精神疾病的人中可以观察到改善，或者这种类型的 训练实际上会在假定的支持反应抑制的潜在大脑区域产生变化， 工作记忆在这项研究中，我们将招募报告高度紧迫的成年患者， 在密集的部分住院方案中治疗精神疾病的急性症状。患者将 随机分配接受常规治疗（TAU）或接受为期两周的TAU加强治疗 针对反应抑制和工作记忆的计算机化认知训练计划。所有参与者将 在基线和从脑电刺激器放电时进行脑活动（EEG）的电生理记录。 程序，以测试与反应抑制和工作记忆相关的大脑活动的变化。的 本项目的目标是（1）确认认知训练干预成功地参与了潜在的 大脑机制;（2）测试这种训练是否与抑郁症的临床改善有关， 自我伤害的冲动，或使用物质的冲动;（3）评估患者使用的可行性和可接受性 在自然主义的背景下进行干预。如果成功的话，这项研究可能会提供证据，证明这种新方法 有效地治疗冲动，涉及潜在的生物机制，临床有效， 适用于现实世界的临床环境。这些目标与NIMH的第三个战略目标高度一致， 它指出，“挑战是测试. 疾病的机制。这就要求干预措施与目标接触，并测试其减少 症状”。本研究接受了这一挑战，以快速测试针对认知障碍的治疗。 一种对心理健康有严重后果的特质的潜在机制。