Understanding and targeting stress reactivity in women Veterans with alcohol misuse

了解并针对酗酒的女性退伍军人的压力反应

• 批准号: 10041692
• 负责人: Cathryn Glanton Holzhauer
• 金额: --
• 依托单位: NORTHAMPTON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10041692
• 关键词: Acute; Alcohol abuse; Alcohol consumption; Alcohols; Allopregnanolone; Arousal; Behavioral; Caring; Clinical; Cognitive; Control Groups; Data Collection; Development; Educational process of instructing; Effectiveness; Emotions; Exhibits; Female; Goals; Grant; Health; Hormonal; Influentials; Intervention; K-Series Research Career Programs; Knowledge; Laboratories; Laboratory Finding; Learning; Measures; Medical; Menstrual cycle; Mental Health; Mentors; Metabolism; Methodology; Methods; Neurobiology; Outcome; Outcome Measure; Outcome Study; Ovarian hormone; Participant; Pathway interactions; Persons; Phase; Physiological; Pilot Projects; Population; Post-Traumatic Stress Disorders; Process; Progesterone; Protocols documentation; Randomized; Research; Research Methodology; Research Personnel; Research Training; Risk; Schedule; Serum; Severities; Strategic Planning; Stress; Stressful Event; Suicide; Testing; Therapeutic; Time; Training; Trauma; Treatment Effectiveness; Underserved Population; Veterans; Veterans Health Administration; Woman; Women' s Health; addiction; alcohol craving; alcohol misuse; alcohol use disorder; behavioral health; career development; cognitive control; cognitive process; cognitive reappraisal; comorbidity; coping; craving; design; drinking; drinking behavior; emotion regulation; experience; heart rate variability; high risk; improved; innovation; male; men; military veteran; novel; novel strategies; personalized care; personalized medicine; prevent; programs; randomized trial; response; skills; statistics; stress reactivity; stressor; substance misuse; substance use

Objectives: The overall objective of the proposed CDA-2, “Understanding and targeting stress reactivity in women Veterans with alcohol misuse”, is for the candidate to receive mentored training on, and to develop skills for, conducting research among women Veterans. Women are expected to comprise 35% of the U.S. Veteran population by 2035, making them the fastest growing segment of VHA users. Within this growing population, understanding their particular clinical needs will become increasingly important. Alcohol misuse is one clinical issue salient for women Veterans. Recent estimates of lifetime alcohol use disorder among women Veterans are up to 27%, equaling those of their male counterparts and exceeding those of civilian women, and women with alcohol misuse have high rates of co-occurring posttraumatic stress disorder (PTSD). Training goals of the CDA-2 grant include learning novel research methods, neurobiological markers of stress and addiction, advanced statistics, and professional development, all within the context of improving care for women Veterans. Aims for the study proposed in this CDA-2 project are two-fold: 1. conduct a randomized trial testing the effects of an emotion regulation skill (cognitive reappraisal) on stress-induced drinking among women with alcohol misuse and varying levels of co-occurring PTSD; 2. examine whether progesterone levels and/or severity of co-occurring PTSD – factors which impact women’s stress reactivity and emotion regulation – moderate the effectiveness of the cognitive reappraisal in reducing stress-induced drinking. Research has shown that serum levels of progesterone and its metabolites are associated with less stress reactivity, less alcohol craving and use, and better ability to regulate emotion. Women with PTSD, however, exhibit a deficit in progesterone metabolism, and women’s alcohol use and craving has been shown to fluctuate across the menstrual cycle. This research suggests that women with low progesterone levels, within the context of menstrual cycle phase or co-occurring PTSD, may be particularly prone to stress-induced drinking and may benefit from learning and using effective emotion regulation skills. Methods: The proposed study will use innovative methodology, combining experimental sessions in a randomized trial with daily longitudinal data collection. Each woman Veteran (n=60) will be randomized to one of two conditions: a control condition (n=30) or a condition in which participants learn to use cognitive reappraisal to regulate stress and negative emotion (n=30). Women in the cognitive reappraisal condition will be asked to practice and use this skill over a 35-day period (to encompass an entire menstrual cycle), and will complete daily logs of alcohol use and stress. Each participant will come in for two experimental sessions, scheduled at the time of her peak and lowest progesterone levels, during which participants in the cognitive reappraisal condition will use that skill in response to a personalized stress induction. Throughout these sessions, the effect of cognitive reappraisal on the following variables (after the stress induction) will be assessed: (1) alcohol craving, (2) inhibitory (cognitive) control, and (3) physiological arousal (heart rate variability). These three variables, and (4) stress-induced drinking during the 35-day period, will be the main study outcome variables. Results/Implications: Results from this study will enhance knowledge of at-risk groups of Veterans (women Veterans with mental health conditions) with Veteran-salient illnesses (PTSD and alcohol misuse) and advance the field of personalized medicine to improve the effectiveness of treatment. The study uses a novel approach (“microintervention” design) which isolates therapeutic strategies typically taught in larger therapeutic protocols, to understand their effects. The training and experiences included in this CDA-2 will provide the candidate with skills and knowledge in studying stress, substance use, and cognitive control among women Veterans. The line of research and training will facilitate the candidate’s career development, accelerating her progression in becoming a women’s health researcher in the VA.

目的：拟议的CDA-2的总体目标，“了解和针对应激反应， 妇女退伍军人与酒精滥用”，是为候选人接受指导培训，并制定 技能，在女性退伍军人中进行研究。预计女性将占美国人口的35% 到2035年，退伍军人将成为VHA用户中增长最快的部分。在这不断增长的 因此，了解他们的特殊临床需求将变得越来越重要。酒精滥用是 对于女性退伍军人来说，一个突出的临床问题。女性终生酒精使用障碍的最新估计 退伍军人的比例高达27%，与男性相当，超过了平民妇女， 滥用酒精的妇女有很高的并发创伤后应激障碍（PTSD）的比率。培训 CDA-2资助的目标包括学习新的研究方法，压力的神经生物学标志物， 成瘾，先进的统计数据和专业发展，所有这些都是在改善护理的背景下进行的。 女性退伍军人。CDA-2项目中提出的研究目标有两个方面：1。进行随机试验 测试情绪调节技能（认知重新评估）对压力诱导饮酒的影响， 女性酒精滥用和不同程度的共同发生的创伤后应激障碍; 2。检查孕酮水平 和/或共同发生的创伤后应激障碍的严重程度-影响女性压力反应和情绪调节的因素 - 降低认知重新评估在减少压力诱导饮酒方面的有效性。研究 表明血清孕酮及其代谢物水平与较低的应激反应， 酒精的渴望和使用，以及更好的调节情绪的能力。然而，患有创伤后应激障碍的女性在以下方面表现出缺陷： 孕激素代谢，女性的酒精使用和渴望已被证明是波动在整个 月经周期这项研究表明，低孕酮水平的妇女，在这种情况下， 月经周期阶段或共同发生的创伤后应激障碍，可能特别容易受到压力引起的饮酒， 从学习和使用有效的情绪调节技能中受益。方法：拟议的研究将使用 创新方法，将随机试验中的实验会话与每日纵向数据相结合 收藏.每名女性退伍军人（n=60）将被随机分配至两种条件之一：对照条件（n=30） 或者是参与者学习使用认知重新评估来调节压力和负面情绪的情况 （n=30）。在认知重新评价条件下的女性将被要求在35天内练习和使用这种技能 月经周期（包括整个月经周期），并将完成酒精使用和压力的每日日志。每个 参与者将在她的高峰和低谷时间进行两次实验 孕酮水平，在此期间，认知重新评估条件下的参与者将使用这种技能， 对个性化压力诱导的反应。在这些会议中，认知重新评价对 将评估以下变量（在应激诱导后）：（1）酒精渴望，（2）抑制（认知） 控制，和（3）生理唤醒（心率变异性）。这三个变量，以及（4）应力诱导 在35天内饮酒，将是主要的研究结果变量。结果/影响：结果 这项研究将提高对退伍军人高危群体（有心理健康问题的女性退伍军人）的认识 条件）与退伍军人突出的疾病（创伤后应激障碍和酒精滥用），并推进个性化领域 提高治疗效果的药物。这项研究使用了一种新的方法（“微干预”） 设计），其隔离通常在较大的治疗方案中教导的治疗策略，以了解其 方面的影响. CDA-2中包含的培训和经验将为候选人提供技能和 在研究妇女退伍军人的压力、物质使用和认知控制方面的知识。线 研究和培训将促进候选人的职业发展，加速她在 成为退伍军人事务部的女性健康研究员