Neurobehavioral Assessment of Interpersonal Functioning in PTSD

描述（由申请人提供）： 摘要愤怒和攻击性是创伤后应激障碍（PTSD）治疗中严重且常见的并发症。现在许多研究表明，人际攻击和愤怒：i）与创伤后应激障碍密切相关（对于元分析，参见Orth & Wieland，2006）; ii）在患有与战斗有关的PTSD的个体中特别有害（Novaco & Chemtob，2002）;以及iii）有效治疗与战斗有关的PTSD的关键障碍（福布斯等人，2003;福布斯等人，2008年）。尽管愤怒和攻击性对患有创伤后应激障碍的退伍军人的生活产生了有害影响，尽管愤怒和攻击性对治疗和康复构成了障碍，但人们对创伤后应激障碍中人际攻击性的神经行为病理学或创伤后应激障碍个体更普遍地参与合作互动的能力知之甚少。拟议研究的广泛目标是解决这些问题。也就是说，我们试图确定客观的行为和神经指标的侵略，有助于受损的社会交往的个人与战斗相关的创伤后应激障碍。为了实现这一目标，拟议的项目旨在：7量化患有创伤后应激障碍的退伍军人和与战斗匹配的对照退伍军人在攻击性和非攻击性人际交流期间的行为决策和相关的神经活动。图7量化患有PTSD的退伍军人和战斗匹配的对照退伍军人在合作和非合作人际交流期间的行为决定和相关神经活动。 第7章探索创伤后应激障碍中攻击性和合作性的诊断差异是否与理解社交伙伴的想法和意图相关的神经结构功能减弱有关。与战斗相关的创伤后应激障碍的人际关系困难的客观神经行为措施的发展将有助于早期识别退伍军人需要治疗，并可能有助于设计和实施有针对性的治疗干预措施。 公共卫生相关性： 愤怒和攻击性是创伤后应激障碍退伍军人康复的关键障碍，并阻碍了他们健康的人际关系。愤怒和侵略的影响不仅对我们的退伍军人的生活，而且对退伍军人的家庭和社区都是毁灭性的。这种社会影响是明确的。我们从媒体报道和流行病学研究中看到，患有创伤后应激障碍的退伍军人表现出很高的攻击性，战斗退伍军人的离婚率比普通人群高出60%。虽然对创伤后应激障碍中攻击性和治疗结果之间的特定关系的研究正在进行中，但迄今为止最好的证据表明，愤怒预测创伤后应激障碍中的不良治疗结果：治疗结果的最强预测因素是退伍军人对自己愤怒的恐惧-也就是说，愤怒的含义和后果（福布斯等人，2008年）。因此，那些感觉最不能控制自己的愤怒和攻击性的退伍军人，最不能从目前的创伤后应激障碍治疗方案中受益。虽然这些数据是毋庸置疑的，但在了解如何识别和治疗患有创伤后应激障碍的退伍军人的社会困难方面几乎没有取得进展。对于导致PTSD患者人际交往困难的神经行为机制，人们的了解更少。我们所提出的研究的广泛目标是解决这些领域。也就是说，我们希望确定愤怒和攻击的客观行为和神经机制，这些机制影响与战斗相关的PTSD个体的社会互动。我们认为，新的，客观的，和敏感的措施，在创伤后应激障碍的人际功能，如这里提出的是必要的，以确定退伍军人谁可能需要帮助，并制定个性化的治疗，帮助退伍军人保持健康的社区关系。

DESCRIPTION (provided by applicant): ABSTRACT Anger and aggression are serious and frequent complicating factors in the treatment of post-traumatic stress disorder (PTSD). A host of studies now demonstrate that interpersonal aggression and anger are: i) strongly associated with post-traumatic stress disorder (for meta-analysis, see Orth & Wieland, 2006); ii) particularly pernicious among individuals with combat-related PTSD (Novaco & Chemtob, 2002); and, iii) critical barriers to effective treatment in combat-related PTSD (Forbes et al., 2003; Forbes et al., 2008). Despite the detrimental impact that anger and aggression have on the lives of combat veterans with PTSD, and despite the barrier that anger and aggression pose to treatment and recovery, very little is understood about the neurobehavioral pathology underlying interpersonal aggression in PTSD, or the capacity of individuals with PTSD to engage in cooperative interactions more generally. The broad goal of the proposed research is to address these areas. That is, we seek to identify objective behavioral and neural metrics of aggression that contribute to impaired social interactions of individuals with combat- related PTSD. To achieve this goal, the proposed project seeks to: 7 Quantify behavioral decisions and associated neural activity during aggressive and non- aggressive interpersonal exchanges among veterans with PTSD and combat-matched control veterans. 7 Quantify behavioral decisions and associated neural activity during cooperative and non- cooperative interpersonal exchanges among veterans with PTSD and combat-matched control veterans. 7 Explore whether diagnostic differences in aggression and cooperation in PTSD are related to diminished function of neural structures associated with understanding the thoughts and intentions of social partners. The development of objective neurobehavioral measures of interpersonal difficulties associated with combat-related PTSD will facilitate early identification of veterans in need of treatment, and may aid in design and implementation of targeted therapeutic interventions. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE Anger and aggression present critical barriers to recovery and prevent healthy interpersonal relationships among veterans with PTSD. The effects of anger and aggression are devastating not only to our veterans' lives, but also to veterans' families and communities. This social impact is unambiguous. We see from media reports and epidemiology studies that veterans with PTSD show high rates of aggression, and divorce rates among combat veterans are up to 60% higher than in the general population. While research into the specific relationship between aggression and treatment outcome in PTSD is ongoing, the best evidence to date indicates that anger predicts poor treatment outcome in PTSD: the strongest predictor of treatment outcome is a veteran's fear of their own anger - that is, the implications and consequences of that anger (Forbes et al., 2008). Thus, it is the veterans who feel least able to control their own anger and aggression who are least able to benefit from current treatment protocols for PTSD. While these data are unquestionable, little progress has been made toward understanding how to identify and treat the social difficulties of veterans with PTSD. Even less is understood about the neurobehavioral mechanisms that contribute to interpersonal difficulties in PTSD. The broad goal of our proposed research is to address these areas. That is, we hope to identify objective behavioral and neural mechanisms of anger and aggression that impact the social interactions of individuals with combat-related PTSD. We believe that novel, objective, and sensitive measures of interpersonal functioning in PTSD such as that proposed here are necessary to identify veterans who may need assistance and develop personalized treatments for helping veterans maintain healthy community relationships.