Marijuana Use, Extinction Learning, and Exposure Therapy in Individuals with PTSD

创伤后应激障碍 (PTSD) 患者的大麻使用、消退学习和暴露疗法

• 批准号: 9267954
• 负责人: MICHELE A BEDARD-Gilligan
• 金额: $ 17.91万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9267954
• 关键词: Acoustics; Affect; Agonist; Alcohol or Other Drugs use; Amygdaloid structure; Animals; Anxiety; Anxiety Disorders; Attenuated; Basic Science; Behavioral; Biological; Blood Pressure; CNR1 gene; Cannabinoids; Chronic; Clinical; Clinical Sciences; Comorbidity; Cues; Discrimination; Dose; Drops; Extinction (Psychology); Fright; Galvanic Skin Response; Hippocampus (Brain); Human; Hydrocortisone; Impairment; Individual; Intervention; Investigation; Knowledge; Learning; Link; Marijuana; Medical; Monitor; Neurobiology; Outcome; Participant; Pathologic; Patients; Physiological; Population; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Protocols documentation; Psychopathology; Public Health; Randomized; Recovery; Recruitment Activity; Research; Risk; Sampling; Signal Transduction; Societies; System; Testing; Therapeutic; Therapeutic Effect; Time; Translating; Trauma; Treatment Protocols; Treatment outcome; Urine; Work; brief intervention; conditioning; cost; design; emotional experience; health care service utilization; high risk; improved; innovation; learning extinction; marijuana use; marijuana user; neurobiological mechanism; novel; predictive of treatment response; public health relevance; response; symptomatic improvement; treatment response

 DESCRIPTION (provided by applicant): Following trauma exposure a substantial number of individuals will go on to develop psychopathology, such as posttraumatic stress disorder (PTSD), and many also develop co-occurring substance use, such as marijuana use. Their co-occurrence is costly to both the victim and society as a whole. The co-occurrence of PTSD and marijuana use is predictive of poorer outcome and increased drop out from PTSD treatment. Exposure therapy, a first line intervention for PTSD, is theorized to work through extinction processes, and marijuana has known effects on extinction learning. Thus, a better understanding of the relationship between marijuana and extinction learning, in both experimental and treatment contexts, can help us better understand how to best intervene with this population. This project is designed to integrate basic and clinical science to translate mechanisms of recovery from PTSD to testing an intervention in individuals with PTSD and marijuana use. We will recruit 72 individuals with PTSD and varying levels of marijuana use, 36 with current heavy marijuana use and 36 without current marijuana use, to complete a conditional discrimination and extinction task in order to understand the relationship between marijuana and fear learning in individuals with pathological fear. Following this task, participant will be randomized to either a brief 6 session imaginal exposure protocol (IE) or a standard 10 session prolonged exposure protocol (PE) to explore whether the adapted short form treatment shows increased feasibility (efficacy, reduced drop out) for individuals with co-occurring PTSD and marijuana use. We will also be able to test the link between basic fear and recovery processes by looking at the extinction task as a predictor of treatment response for individuals with and without marijuana use. This research is significant in its potential to identify a predictr of treatment response, to test an underlying mechanism of recovery for PTSD in individuals with PTSD and co-occurring marijuana use, and to test feasibility of a novel intervention for a difficul to treat population.

 描述（由申请人提供）：经历创伤后，相当多的人会继续发展精神病理学，例如创伤后应激障碍（PTSD），并且许多人还会同时发生物质使用，例如吸食大麻。它们的同时发生对于受害者和整个社会来说都是代价高昂的。创伤后应激障碍 (PTSD) 和吸食大麻的同时发生预示着治疗结果较差，并且 PTSD 治疗退出率增加。暴露疗法是创伤后应激障碍 (PTSD) 的一线干预措施，理论上可以通过消退过程发挥作用，而大麻对消退学习也有已知的影响。因此，在实验和治疗背景下更好地了解大麻和灭绝学习之间的关系可以帮助我们更好地了解如何最好地干预这一人群。该项目旨在整合基础科学和临床科学，将 PTSD 的恢复机制转化为测试对患有 PTSD 和吸食大麻的个体的干预措施。我们将招募 72 名患有 PTSD 且吸食不同程度大麻的个体，其中 36 名目前大量吸食大麻，36 名目前没有吸食大麻，来完成条件歧视和灭绝任务，以了解大麻与病理性恐惧个体的恐惧学习之间的关系。完成这项任务后，参与者将被随机分配到简短的 6 节想象暴露方案 (IE) 或标准的 10 节长时间暴露方案 (PE)，以探索调整后的短期治疗对于同时发生 PTSD 和大麻使用的个体是否显示出更高的可行性（功效、减少退出）。我们还可以通过将灭绝任务视为吸食和不吸食大麻的个体治疗反应的预测因子，来测试基本恐惧和恢复过程之间的联系。这项研究具有重要意义，因为它有潜力确定治疗反应的预测因素，测试患有创伤后应激障碍和同时吸食大麻的个体恢复创伤后应激障碍的潜在机制，并测试针对难以治疗的人群的新型干预措施的可行性。