Cognitive Training as a Novel Neuroscience-based Treatment for PTSD

认知训练作为一种基于神经科学的新型创伤后应激障碍治疗方法

• 批准号: 10563117
• 负责人: Jessica Bomyea
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10563117
• 关键词: Affect; Affective; Affective Symptoms; Aftercare; Anterior; Award; Brain; Chronic; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Coupled; Data; Development; Diagnostic; Disease; Disease model; E-learning; Educational Intervention; Emotional; Emotions; Etiology; Exercise; Functional Magnetic Resonance Imaging; Goals; Individual; Intervention; Intervention Studies; Interview; Learning; Measures; Memory; Mental Health; Mental disorders; Mentors; Methods; Modification; Neurobehavioral Manifestations; Neurobiology; Neurocognitive; Neurophysiology - biologic function; Neuropsychology; Neurosciences; Participant; Pattern; Performance; Physiological; Post-Traumatic Stress Disorders; Prediction of Response to Therapy; Prefrontal Cortex; Preparation; Process; Psyche structure; Randomized, Controlled Trials; Research; Research Personnel; Research Training; Role; Scientist; Secondary to; Services; Short-Term Memory; Subgroup; Symptoms; System; Techniques; Thinking; Time; Training; Training Programs; Training Technics; Translating; Trauma; Veterans; Woman; alternative treatment; base; cognitive control; cognitive enhancement; cognitive rehabilitation; cognitive system; cognitive training; computerized; design; effective therapy; effectiveness study; emotional symptom; evidence base; executive function; experience; follow-up; functional improvement; improved; intervention effect; intervention program; neural; neurobiological mechanism; neuroimaging; novel; primary outcome; programs; psychosocial; recruit; reduce symptoms; sexual assault; skills; symptomatic improvement; therapy development; tool; traumatic stress; treatment response; trial design; web platform

Posttraumatic stress disorder (PTSD) is a chronic, disabling condition that occurs in a subgroup of individuals after experiencing traumatic stress, and is common in Veterans seeking mental health treatment at the VA. Although evidence-based psychosocial treatments exist for PTSD, a substantial portion of individuals do not fully respond to treatment. Thus, there is a clear need to continue researching novel interventions for PTSD in Veterans. Recently, new interventions for mental health disorders have utilized computerized cognitive training techniques in order to improve the functioning of cognitive systems and reduce symptoms. This type of intervention, often referred to as neurotherapeutics, may hold promise for PTSD as a method for ameliorating symptoms and improving cognition. Individuals with PTSD demonstrate difficulties with cognitive control functions, which appear to be causally implicated in symptoms of the disorder (e.g., intrusive trauma- related memories). To date the efficacy of neurotherapeutics for PTSD has been understudied in Veterans. The current proposal aims to bridge research on basic neurocognitive mechanisms of PTSD with intervention research by conducting a randomized controlled trial (RCT) of a cognitive control training program in 80 Veterans with PTSD. Veterans will complete computer-based training exercises designed to specifically target and improve aspects of cognitive control. Veterans will complete the program twice per week for eight weeks. Symptoms will be assessed before and after treatment, as well as at a two- month follow up time point. The primary goal of the study is to examine the effect of the intervention on PTSD symptoms and cognitive deficits. Evaluating symptom change as a result of the intervention will provide critical data regarding the utility of this program as a PTSD treatment. If effective, this training program could serve as alternative treatment option for Veterans with PTSD, and could be translated into an easily transportable intervention for dissemination (e.g., through web-based platforms). A secondary goal is to use functional magnetic resonance imaging (fMRI) to better understand the mechanisms by which cognitive training culminates in symptom reduction. If training cognitive control with neurotherapeutics directly enhances functioning of specific neural substrates as hypothesized, improvements in affective processes relying on shared neural regions would also be predicted. Modifying functioning in these substrates with training may thus reduce symptoms by improving neural functioning while processing and managing trauma-related affect and information. Neural systems used for cognitive control targeted in the training described (e.g., dorsolateral prefrontal cortex [dlPFC]) are also recruited when individuals mentally manipulate emotional information, such as when individuals use reappraisal to change the way that they think about negative emotional situations or content. In this study, Veterans will complete a neutral cognitive control task and a reappraisal task while undergoing fMRI before and after completing the training treatment. This will be the first study to evaluate neurobiological mechanisms of this type of training in PTSD, which is a fundamental next step for understanding how to improve the training program and who may be best served by completing it. Building upon the applicant's prior experience with clinical trials and cognitive training research, the proposed training plan provides an opportunity for new hands-on training in neuropsychology, cognitive rehabilitation, and functional neuroimaging techniques to meet the immediate goal of developing skills in these domains. Long term, the award will facilitate development of expertise with integration of neurobiological tools with intervention research, and provide critical pilot data for successful preparation of a VA Merit Award. Together, the research and training plan will make the applicant well-poised to transition to an independent clinical scientist role within the VA system.

创伤后应激障碍（PTSD）是一种慢性残疾状况，发生在 个人经历了创伤性压力后，在寻求心理健康治疗的退伍军人中很常见 VA。尽管有针对PTSD的基于循证的社会心理治疗，但很大一部分个体 不要完全对治疗做出反应。因此，显然需要继续研究新的干预措施 退伍军人的PTSD。最近，针对心理健康障碍的新干预措施已经使用了计算机 认知训练技术是为了改善认知系统的功能并减轻症状。 这种类型的干预措施通常称为神经疗法，可能对PTSD有望作为一种方法 改善症状并改善认知。具有PTSD的人表现出认知困难 控制功能似乎与该疾病的症状有关（例如，侵入性创伤 - 相关记忆）。迄今为止，在退伍军人中，神经疗法对PTSD的疗效已经研究了。 当前的提案旨在与PTSD基本神经认知机制进行研究 通过进行认知控制训练的随机对照试验（RCT），干预研究 与PTSD的80名退伍军人计划。退伍军人将完成设计的基于计算机的培训练习 专门针对和改善认知控制的方面。退伍军人将两次完成该计划 每周八周。症状将在治疗前后评估，以及 一个月随访时间点。该研究的主要目的是检查干预对 PTSD症状和认知缺陷。评估症状变化是由于干预措施的 提供有关该程序作为PTSD治疗的效用的关键数据。如果有效，这项培训 计划可以作为具有PTSD的退伍军人的替代治疗选择，可以转化为 易于运输的传播干预措施（例如，通过基于Web的平台）。次要 目标是使用功能磁共振成像（fMRI）更好地理解机制 认知训练最终导致症状减轻。如果训练认知控制 神经疗法直接增强特定神经底物的功能，如假设 还将预测依靠共同神经区域的情感过程的改善。修改 因此，通过训练在这些底物中功能可以通过改善神经功能来减轻症状 同时处理和管理与创伤有关的影响和信息。用于认知的神经系统 还招募了针对描述的训练中的对照（例如，背外侧前额叶皮层[DLPFC]） 当个人在精神上操纵情感信息时，例如个人使用重新评估 改变他们考虑负面情绪情况或内容的方式。在这项研究中，退伍军人将 完成一项中性认知控制任务和重新评估任务，同时在之前和之后进行fMRI 完成培训治疗。这将是评估神经生物学机制的第一项研究 这种类型的PTSD培训，这是了解如何改善的基本下一步 培训计划以及完成该计划最好的服务。 在申请人先前在临床试验和认知培训研究的经验的基础上， 拟议的培训计划为神经心理学的新动手培训提供了机会， 认知康复和功能性神经影像学技术，以实现发展的直接目标 这些领域的技能。长期，该奖项将促进与整合的专业知识的发展 通过干预研究的神经生物学工具，并提供关键的试点数据以成功准备 VA功绩奖。研究和培训计划一起将使申请人充分付出 过渡到VA系统中的独立临床科学家角色。

项目成果

Relationships between daily mood states and real-time cognitive performance in individuals with bipolar disorder and healthy comparators: A remote ambulatory assessment study.

• DOI: 10.1080/13803395.2021.1975656
• 发表时间: 2021-10
• 期刊: Journal of clinical and experimental neuropsychology
• 影响因子: 2.2
• 作者: Bomyea JA;Parrish EM;Paolillo EW;Filip TF;Eyler LT;Depp CA;Moore RC
• 通讯作者: Moore RC

Can Applying Neuroanatomical Precision Advance Our Models and Treatment of Posttraumatic Stress Disorder?

• DOI: 10.1016/j.bpsc.2020.01.009
• 发表时间: 2020-03
• 期刊: Biological psychiatry. Cognitive neuroscience and neuroimaging

Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study.

• DOI: 10.2196/36665
• 发表时间: 2022-07-29
• 期刊: JOURNAL OF MEDICAL INTERNET RESEARCH
• 影响因子: 7.4
• 作者: Moore, Raeanne C.;Parrish, Emma M.;Van Patten, Ryan;Paolillo, Emily;Filip, Tess F.;Bomyea, Jessica;Lomas, Derek;Twamley, Elizabeth W.;Eyler, Lisa T.;Depp, Colin A.
• 通讯作者: Depp, Colin A.

Neurocognitive markers of childhood abuse in individuals with PTSD: Findings from the INTRuST Clinical Consortium.

• DOI: 10.1016/j.jpsychires.2019.11.012
• 发表时间: 2020-02
• 期刊: Journal of psychiatric research
• 影响因子: 4.8
• 作者: Bomyea J;Simmons AN;Shenton ME;Coleman MJ;Bouix S;Rathi Y;Pasternak O;Coimbra R;Shutter L;George MS;Grant G;Zafonte RD;McAllister TW;Stein MB;INTRuST consortium
• 通讯作者: INTRuST consortium