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

 描述(由申请人提供)：在创伤暴露后，相当数量的人将继续发展为精神病理学，如创伤后应激障碍(PTSD)，许多人还会同时发生药物使用，如吸食大麻。它们的共同发生对受害者和整个社会都是代价高昂的。同时出现创伤后应激障碍和大麻使用预示着较差的结局和从创伤后应激障碍治疗中辍学的增加。暴露疗法是治疗创伤后应激障碍的第一线干预措施，理论上认为它在消亡过程中起作用，而大麻对消退学习有已知的影响。因此，在实验和治疗的情况下，更好地理解大麻和灭绝学习之间的关系，可以帮助我们更好地理解如何最好地干预这一群体。该项目旨在整合基础和临床科学，将创伤后应激障碍的康复机制转化为对创伤后应激障碍和大麻使用者的干预。我们将招募72名患有创伤后应激障碍和不同程度使用大麻的人，36名目前大量使用大麻的人和36名目前没有使用大麻的人来完成条件辨别和戒除任务，以了解病理性恐惧个体中大麻和恐惧学习之间的关系。在这项任务之后，参与者将被随机分成6个疗程的短暂想象暴露方案(IE)或标准的10个疗程延长暴露方案(PE)，以探索适应的短期治疗是否显示出对同时存在PTSD和大麻使用的个人更具可行性(有效性，减少辍学)。我们还将能够通过观察灭绝任务来测试基本恐惧和康复过程之间的联系，将其作为预测使用和不使用大麻的个人治疗反应的指标。这项研究在确定治疗反应的预测，测试患有创伤后应激障碍和同时使用大麻的个人的创伤后应激障碍恢复的潜在机制，以及测试一种新的干预措施治疗困难人群的可行性方面具有重要意义。

 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.