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，相当多的人将继续发展精神病理学，如创伤后应激障碍（PTSD），许多人还发展共同发生的物质使用，如大麻使用。它们同时发生对受害者和整个社会都是代价高昂的。PTSD和大麻使用的共同发生预示着更差的结果和增加PTSD治疗的退出。暴露疗法是PTSD的一线干预措施，理论上可以通过灭绝过程发挥作用，大麻对灭绝学习有已知的影响。因此，更好地了解大麻和灭绝学习之间的关系，在实验和治疗背景下，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和临床科学，将创伤后应激障碍的恢复机制转化为对创伤后应激障碍和大麻使用者的干预测试。我们将招募72名患有创伤后应激障碍和不同程度大麻使用的个体，其中36名目前重度使用大麻，36名目前没有使用大麻，以完成有条件的歧视和灭绝任务，以了解大麻与病理性恐惧个体的恐惧学习之间的关系。在该任务之后，参与者将被随机分配至简短的6个疗程的想象暴露方案（IE）或标准的10个疗程的延长暴露方案（PE），以探索适应的短形式治疗是否显示出对于患有共同发生的PTSD和大麻使用的个体的增加的可行性（功效，减少的脱落）。我们还将能够测试基本恐惧和恢复过程之间的联系，通过将灭绝任务视为使用和不使用大麻的个人的治疗反应的预测因素。这项研究具有重要意义，因为它有可能确定治疗反应的预测因子，测试PTSD患者和同时使用大麻的患者PTSD恢复的潜在机制，并测试一种新的干预措施对难以治疗人群的可行性。

 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.