Neural connectivity before and after each of the three treatment phases of trauma-focused therapy for adolescent posttraumatic stress

青少年创伤后应激障碍创伤聚焦治疗三个治疗阶段前后的神经连接

• 批准号: 10622598
• 负责人: AMY S GARRETT
• 金额: $ 77.51万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10622598
• 关键词: Adolescence; Adolescent; Aftercare; Age; Amygdaloid structure; Anterior; Behavioral; Brain; Brain region; Child; Clinical Trials; Cognitive; Cognitive Therapy; Communities; Consultations; Cues; Data; Development; Dorsal; Early Intervention; Emotional; Functional Magnetic Resonance Imaging; Goals; Impairment; Individual Differences; Investigation; Learning; Left; Link; Long-Term Effects; Methods; Modeling; Neuroanatomy; Neurobiology; Participant; Patients; Pattern; Phase; Population; Post-Traumatic Stress Disorders; Process; Provider; Psychotherapy; Randomized; Randomized, Controlled Trials; Regulation; Research; Scanning; Series; Severities; Sexual abuse; Social Functioning; Structure; Symptoms; Testing; Therapeutic; Trauma; Treatment Protocols; Violence; Youth; abuse victim; biomarker development; boys; brain dysfunction; cognitive function; coping; effective therapy; efficacious treatment; emotional functioning; evidence base; executive function; experience; flexibility; girls; gray matter; habituation; improved; innovation; interpersonal trauma; neural; neurobiological mechanism; neuroimaging; neuromechanism; novel; novel strategies; personalized medicine; physical abuse; post-traumatic stress; recruit; reduce symptoms; response; sex; skill acquisition; skills; social; social skills; symptom treatment; symptomatic improvement; time interval; trauma exposure; treatment as usual; trial design; white matter

PROJECT SUMMARY Posttraumatic stress disorder (PTSD) during adolescence negatively impacts brain networks underlying cognitive, social, and emotional function. Early intervention is important for mitigating long-term effects, but about 20% of youth do not improve sufficiently with current approaches. By identifying the neurobiological mechanisms of effective therapies, we facilitate the development of novel or personalized treatment approaches for youth with PTSD. However, there has been limited progress in identifying the neural mechanisms of treatment using neuroimaging, partly because most studies collect neuroimaging data at only baseline and end-of-treatment, which collapses across multiple parts of the therapeutic process. The objective of the proposed study is to take a new approach by identifying neural mechanisms associated with specific phases of trauma therapy for youth with PTSD. Our central hypothesis is that each phase produces specific brain changes that reflect the acquisition of skills and experiences occurring during that phase. Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) is evidence-based and widely-used to treat children and adolescents with PTSD. It consists of 3 well-defined phases, providing an opportunity to test our hypotheses with neuroimaging: changes in executive control networks will occur during the skills phase, changes in limbic networks during the narrative phase, and changes in default mode networks during the consolidation phase. To test these hypotheses, we will recruit N=180 girls and boys, ages 12-17, who have PTSD following interpersonal trauma, such as physical abuse, sexual abuse, or witnessing violence. We will use a randomized controlled trial design to assign participants to either TF-CBT (provided by study team clinicians who meet fidelity standards and receive consultation from Dr. Judith Cohen, the treatment developer) or Treatment as Usual (TAU; provided in the community and does not follow a phased structure). We will collect functional magnetic resonance imaging (fMRI) data before and after each of the 3 phases of TF-CBT or the same time intervals of TAU. Individual differences in age, sex, dissociative subtype, symptom severity and other variables will be investigated as covariates of phase-related neural changes. Analyses will identify the phases of TF- CBT for which brain regions and networks change for the TF-CBT but not the TAU group. We will also identify the phase(s) that best predict end-of-treatment symptom improvement. Exploratory analyses will use neuroanatomical and white matter diffusivity scans to identify co-occurring changes in brain structure. The proposed innovative study will provide novel information on the neurobiological and cognitive mechanisms associated with the process of trauma therapy for youth with PTSD. 1

项目摘要 青春期期间创伤后应激障碍（PTSD）对脑网络产生负面影响 认知，社会和情感功能。早期干预对于缓解长期影响很重要，但 当前方法，约有20％的年轻人无法充分改善。通过识别神经生物学 有效疗法的机制，我们促进了新颖或个性化治疗的发展 PTSD青年的方法。但是，识别神经的进展有限 使用神经影像学的治疗机制，部分是因为大多数研究仅在仅在 基线和治疗结束，在治疗过程的多个部分崩溃。目标 拟议的研究是通过识别与特定相关的神经机制采用新方法 PTSD青年创伤疗法的阶段。我们的中心假设是每个阶段都会产生特定 大脑变化反映了在此阶段发生的技能和经验的获取。创伤- 专注的认知行为疗法（TF-CBT）是基于循证的，广泛用于治疗儿童和 具有PTSD的青少年。它由3个定义明确的阶段组成，提供了一个检验我们的假设的机会 神经影像学：执行控制网络的变化将在技能阶段发生，边缘的变化 叙事阶段的网络以及合并阶段默认模式网络的变化。 为了检验这些假设，我们将招募12-17岁的180名女孩和男孩，他们的PTSD关注 人际创伤，例如身体虐待，性虐待或目击暴力。我们将使用一个随机的 对照试验设计将参与者分配给TF-CBT（由学习团队临床医生提供 保真标准并从治疗开发人员朱迪思·科恩（Judith Cohen）博士或治疗中获得咨询 通常（Tau；在社区中提供的，并且不遵循分阶段的结构）。我们将收集功能 在TF-CBT的每个阶段或之后，磁共振成像（fMRI）数据或同一时间 tau的间隔。年龄，性别，分离性亚型，症状严重程度和其他变量的个体差异 将作为相关神经变化的协变量进行研究。分析将确定TF-的阶段 TF-CBT的大脑区域和网络为此而不是TAU组发生变化的CBT。我们还将确定 最能预测治疗症状改善的阶段。探索性分析将使用 神经解剖学和白质扩散率扫描以识别大脑结构的同时发生变化。这 拟议的创新研究将提供有关神经生物学和认知机制的新信息 与PTSD青年的创伤疗法有关。 1