Repetitive Transcranial Magnetic Stimulation Augmented Written Exposure Therapy for Veterans with PTSD

针对患有 PTSD 的退伍军人的重复经颅磁刺激增强书面暴露疗法

• 批准号: 10260136
• 负责人: Crystal Lantrip
• 金额: --
• 依托单位: OLIN TEAGUE VETERANS CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10260136
• 关键词: Affect; Affective; Affective Symptoms; Appointment; Area; Attention; Award; Base of the Brain; Behavior Therapy; Behavioral Mechanisms; Brain; Centers of Research Excellence; Clinic; Clinical; Clinical Treatment; Clinical Trials; Cognition; Cognitive; Collaborations; Diagnosis; Dose; Double-Blind Method; Down-Regulation; Effectiveness; Electromagnetics; Emotional; Emotions; Fellowship; Freedom; Future; Goals; Healthcare; Individual Differences; Intervention; Investigation; Length; Magnetism; Mediating; Mediator of activation protein; Mental Depression; Mental Health; Mental disorders; Mentors; Mission; Neurons; Outcome; Patients; Phase; Physiologic pulse; Positioning Attribute; Post-Traumatic Stress Disorders; Prefrontal Cortex; Process; Property; Psychotherapy; Quality of Care; Randomized; Randomized Controlled Trials; Research; Research Personnel; Sampling; Scalp structure; Site; Symptoms; Testing; Time; Training; Trauma; Treatment Effectiveness; Treatment Protocols; Treatment outcome; Up-Regulation; Veterans; War; Woman; Work; base; behavioral study; brain behavior; career; cognitive control; cognitive enhancement; effective intervention; effective therapy; emotion dysregulation; emotion regulation; evidence base; experience; flexibility; improved; men; neuromechanism; novel; operation; reduce symptoms; relating to nervous system; repetitive transcranial magnetic stimulation; symptomatic improvement; theories; trauma exposure; treatment effect; treatment-resistant depression

Post-traumatic stress disorder (PTSD) is highly prevalent among post-deployment Veterans. First line evidence-based psychotherapies (EBPs) for PTSD can be effective, but have limitations including high attrition rates, due in part to lengthy treatment protocols, and continued diagnosis of PTSD in a significant number of patients despite treatment completion. Alternate brain-based treatments are thus being explored, like repetitive transcranial magnetic stimulation (rTMS ), which is useful for depression and shows promise for PTSD. rTMS involves applying a repetitive, brief magnetic pulse to the scalp in order to safely modulate cortical neurons via the dorsolateral prefrontal cortex node, which is believed to improve control of cognition and emotions. Standard rTMS treatments are stand-alone, though the unique properties of rTMS enhancing cognitive control may make it more effective when added to an EBP for PTSD. A brief EBP for PTSD that is effective in as few as five sessions with limited attrition is written exposure therapy (WET). Integration of rTMS with WET could improve efficacy by improving emotional control-dependent cognitive restructuring, which is believed to be WET’s mechanism of action. However, this possibility has not been tested. The applicant, Dr. Lantrip, is a clinical neuropsychologist with expertise in brain -behavior relationships. She has significant experience studying behavioral and neural regulatory processes impacting mental health. Through her postdoctoral fellowship, she developed a theoretical framework for understanding the emotion regulatory mechanisms contributing to symptom improvement in rTMS for depression. She tested this theory in an rTMS clinical trial. Through her current primary VA appointment at the VISN 17 Center of Excellence for Research on Returning War Veterans, Dr. Lantrip has access to a large pool of Veterans with PTSD as well as to a research-dedicated TMS machine. Further, Dr. Lantrip has established collaborations with external researchers who are experts in rTMS treatment in Veterans and in WET. In short, Dr. Lantrip is in an ideal position to conduct the necessary research to augment behavioral therapy for PTSD with rTMS. In the proposed randomized controlled trial, Dr. Lantrip will compare active rTMS added to WET with sham rTMS added to WET in [98] Veterans with PTSD. She will also determine the mechanism of action of the treatment by determining if emotional flexibility is a mediator of treatment outcome. In summary, this project will attempt to augment WET, a brief EBP for PTSD, by adding rTMS, and it will also attempt to determine the emotion regulatory mechanism of action for symptom improvement. If successful, this work will influence both clinical treatment and scientific investigation of PTSD. This project will be of potentially great value to both patients and clinicians within the VA by providing an effective, efficient treatment option for veterans with PTSD. This treatment may also facilitate symptom improvement in transdiagnostic mental health disorders. Upon successful completion of this project, Dr. Lantrip will apply for a VA Merit Review Award with continued investigation into TMS-augmented behavioral intervention for trauma-related illness. By providing Dr. Lantrip with mentored research time to conduct this study, this project will help Dr. Lantrip achieve her goal of becoming an independent VA investigator.

创伤后应激障碍(PTSD)在部署后退伍军人中非常普遍。第一 循证心理疗法(EBPS)对创伤后应激障碍有效，但也有局限性 包括高流失率，部分原因是治疗方案冗长，以及继续诊断为 尽管治疗完成，但仍有相当数量的患者患有创伤后应激障碍。基于大脑的替代方案 因此，人们正在探索治疗方法，如重复经颅磁刺激(RTMS)，它 对抑郁症很有用，对创伤后应激障碍也很有希望。RTMS包括应用重复的、简短的 向头皮施加磁脉冲，以便通过背外侧安全地调制皮质神经元 前额叶皮质结节，被认为可以改善认知和情绪的控制。标准 RTMS治疗是独立的，尽管rTMS的独特特性增强了认知 当控制被添加到治疗创伤后应激障碍的EBP中时，可能会使其更加有效。治疗创伤后应激障碍的简要EBP 在短短五个疗程内有效且消耗有限的是书面暴露疗法(WEW)。 RTMS与WEW的整合可以通过改善情绪控制依赖来提高疗效 认知重建，这被认为是湿润的作用机制。不过，这个 这种可能性还没有得到测试。 申请者兰特里普博士是一位在大脑行为方面有专长的临床神经心理学家。 两性关系。她在研究行为和神经调节过程方面有丰富的经验。 影响心理健康。通过博士后研究，她发展了一种理论 理解导致症状的情绪调节机制的框架 治疗抑郁症的rTMS的改善。她在一项rTMS临床试验中验证了这一理论。通过她 目前在VISN 17归国研究英才中心担任初级退伍军人 退伍军人，兰特里普博士可以接触到一大批患有创伤后应激障碍的退伍军人以及 研发专用TMS机器。此外，兰特里普博士还与外部机构建立了合作关系 研究人员是退伍军人rTMS治疗和湿性治疗方面的专家。简而言之，兰特里普博士在 开展必要的研究以加强创伤后应激障碍的行为治疗的理想职位 RTMS。 在拟议的随机对照试验中，兰特里普博士将比较添加的活性rTMS和湿性rTMS 在[98]患有创伤后应激障碍的退伍军人中加入假rTMS。她还将决定 通过确定情绪灵活性是否是治疗的中介来确定治疗的作用机制 治疗结果。 总之，该项目将尝试通过增加rTMS来增加WEW，这是一种针对创伤后应激障碍简短EBP， 并试图确定症状作用的情绪调节机制 进步。如果成功，这项工作将影响临床治疗和科学研究。 创伤后应激障碍的调查。这一项目对患者和临床医生都有潜在的巨大价值。 通过为患有创伤后应激障碍的退伍军人提供有效、高效的治疗选择，在退伍军人事务部内实现这一目标。这 治疗还可能促进跨诊断精神健康障碍的症状改善。 在成功完成这个项目后，LanTrip博士将申请退伍军人事务部荣誉评审奖 持续调查TMS对创伤相关疾病的强化行为干预。通过 为LanTrip博士提供指导研究的时间来进行这项研究，该项目将帮助Dr。 LanTrip实现了她成为一名独立退伍军人管理局调查员的目标。