Matching Cognitive Remediation to Cognitive Deficits in Substance-Abusing Inmates

描述(由申请人提供)：精神病患者酗酒和吸毒以及各种形式的反社会行为的风险很高(Smith&Newman，1990)。因此，解决与精神病相关的风险因素可能被证明是成功治疗药物滥用的关键，特别是在监禁样本中。在这方面，在区分与情绪反应型或情绪稳定型精神病相关的风险因素方面有很强的先例。虽然这两种类型都与严重的药物滥用有关，但这两种类型的自我控制问题与不同的认知-情感缺陷有关。在拟议的研究中，我们利用最近在区分和表征与这些亚型相关的心理生物学缺陷方面的进展来开发新的认知补救方案，以匹配它们各自的技能缺陷，并评估这些方案是否比那些没有解决假定缺陷的方案产生更大的变化。具体地说，128名被诊断为情绪反应型或情绪稳定型精神病的被监禁罪犯将接受两种基于计算机的干预措施之一，这两种干预旨在培养核心认知技能，这两种技能与情绪反应型或情绪稳定型精神病罪犯的自我调节缺陷有关。一种干预(ACC)针对与情绪反应性罪犯相关的情感认知控制缺陷，而另一种干预(ATC)针对与情绪稳定罪犯相关的情境缺陷。为了评估ACC和ATC在这项初步调查中的影响和特异性，我们将使用治疗前和治疗后的行为和大脑相关测量，这些测量在过去的研究中已被发现用于区分情绪反应性和情绪稳定性的精神变态罪犯。我们预测，一种旨在纠正一组实验者的认知缺陷的治疗方法，将比一种旨在补救另一组实验者的认知缺陷的治疗方法产生显著更大的变化。这项研究的结果将(A)提供重要的基线信息，说明在缺乏旨在将这种训练推广到日常功能的支持认知行为材料的情况下，基于计算机的短暂干预可能带来的变化幅度，以及(B)阐明在这两种类似的反社会但病因学上截然不同的亚型中展示不同治疗反应的合理性。 公共卫生相关性：为了实现实验精神病理学研究进展的潜力，有必要改进技术，将这些进展转化为有意义的治疗干预措施。为此，我们(A)将关于与情绪反应和情绪稳定的罪犯相关的不同心理生物学机制的研究转化为不同的计算机辅助干预，以培训旨在克服他们的缺陷和减少酒精/药物滥用的技能，(B)检查这些以缺陷为重点的干预措施在多大程度上改变了与障碍相关的大脑反应，以及(C)检验缺陷匹配治疗产生显著更大治疗后变化的假设。

DESCRIPTION (provided by applicant): People with psychopathy are at high risk for alcohol and drug abuse as well as diverse forms of antisocial behavior (Smith & Newman, 1990). Thus, addressing the risk factors associated with psychopathy may prove to be crucial for the successful treatment of substance abuse, especially in incarcerated samples. In this regard, there is a strong precedent for differentiating the risk factors associated with emotionally reactive or emotionally stable forms of psychopathy. Although both types are associated with significant substance abuse, the self-control problems of these two subtypes are associated with distinct cognitive-affective deficits. In the proposed research, we use recent progress in distinguishing and characterizing the psychobiological deficits associated with these subtypes to develop novel cognitive remediation protocols that match their respective skill deficits and evaluate whether these protocols result in greater change than those that do not address the putative deficits. Specifically, 128 incarcerated offenders diagnosed with emotionally reactive or emotionally stable forms of psychopathy will receive one of two computer-based interventions designed to develop core cognitive skills that have been linked to self-regulation deficits in either emotionally reactive or emotionally stable psychopathic offenders. One intervention (ACC) targets the affective cognitive control deficits associated with emotionally reactive offenders whereas the other intervention (ATC) targets the attention to context deficits associated with emotionally stable offenders. To evaluate the impact and specificity of the ACC and ATC in this initial investigation, we will use pre- and post-treatment behavioral and brain-related measures that have been found to distinguish emotionally reactive and emotionally stable psychopathic offenders in past research. We predict that a treatment designed to remediate the cognitive deficits of one experimental group will result in significantly greater change than a treatment designed to remediate the cognitive deficits of the other experimental group. The results of the study will (a) provide important baseline information concerning the magnitude of change that may be expected from a brief computer-based intervention in the absence of supporting cognitive-behavioral materials designed to enhance the generalization of such training to daily functioning and (b) shed light on the plausibility of demonstrating differential treatment responses in these two similarly antisocial, but etiologically distinct, subtypes. PUBLIC HEALTH RELEVANCE: To realize the potential of research advances in experimental psychopathology, it is necessary to improve the technology for translating these advances into meaningful therapeutic interventions. Toward this end, we (a) translate research on the distinct psychobiological mechanisms associated with emotionally-reactive and emotionally-stable criminal offenders into distinct computer-assisted interventions that train skills designed to overcome their deficits and reduce alcohol / drug abuse, (b) examine the extent to which these deficit-focused interventions modify brain-related responses associated with the disorders, and (c) test the hypothesis that deficit-matched treatments produce significantly greater post-treatment change.