Differential Extinction of Specific Types of Posttraumatic Emotional Reactivity

描述（申请人提供）：基于我的总体职业目标，即成为一名学术环境中的临床科学家，其工作计划侧重于了解与创伤事件相关的情绪反应范围及其对自然和促进创伤后应激反应恢复的影响，我正在寻求培训1）使用复杂的方法和分析技术，包括创伤相关的实验室诱导和情绪评估; 2）使用实验精神病理学方法来理解创伤后后遗症，包括PTSD; 3）将这些证据应用于针对创伤后问题的治疗和预防计划的开发和完善。拟议的实验室为基础的研究代表了服务于这些目标的关键一步，为我提供了丰富的背景下，检查机制，可以告知量身定制的，以证据为基础的干预措施的发展。因此，拟议的研究利用复杂的实验室程序来比较厌恶和恐惧的情绪反应在重复暴露于性侵犯相关线索时的下降率。具体来说，92名遭受性侵犯的女性将完成一项基于实验室的评估，评估基于厌恶和恐惧的情绪反应，以应对反复暴露于个性化脚本驱动的图像程序。在暴露于以厌恶和恐惧为中心的性侵犯脚本以及中性脚本（对照组）后，将测量情绪反应的变化。参与者将被随机分配到四个组中的一个（2个实验组，2个对照组），他们将反复接触以厌恶和恐惧为重点的性侵犯脚本（实验组）或中性脚本（对照组）。具体研究假设如下：1）总体而言，与基于恐惧的反应相比，重复暴露于性侵犯线索将导致基于厌恶的反应的消退更少，2）与暴露于以恐惧为中心的线索相比，重复暴露于以厌恶为中心的性侵犯线索将导致基于厌恶的反应的消退更大，以及3）重复暴露于以恐惧为中心的性侵犯线索，与暴露于以厌恶为中心的线索相比，将导致更大的基于恐惧的反应消失。基于暴露的程序被纳入最完善的预防计划和治疗性侵犯造成的创伤后应激反应，但接受这种干预措施的人中有相当一部分似乎没有受益，对干预措施反应良好的人通常报告残留症状。因此，本项目旨在了解可能影响基于创伤后应激障碍的干预措施结果的具体过程和机制，以进一步减轻创伤后应激障碍带来的广泛的公共卫生负担。 公共卫生相关性：虽然性侵犯领域的主要学者长期以来一直认为，恐惧以外的情绪可能是创伤后问题的影响干预措施，但目前的项目通过调查暴露于性侵犯的影响-相关线索对厌恶的影响-以及基于恐惧的反应，纳入了这一假设的第一个受控实验室调查之一。这项研究的发现将为专门针对性攻击相关PTSD治疗中基于厌恶的反应的影响的调查奠定基础。这个项目是既显着和临床上重要的，因为它试图更好地了解具体的过程和机制，可能会影响结果的基于创伤后应激障碍的干预措施，以加强干预措施，旨在减轻广泛的公共卫生负担引入创伤后应激障碍。

DESCRIPTION (provided by applicant): Based on my overarching career goal of becoming a clinical scientist in an academic setting with a program of work focused on understanding the range of emotional reactions associated with traumatic events and their affect on both natural and facilitated recovery from posttraumatic stress reactions, I am seeking training in 1) the use of sophisticated methodological and analytic techniques involving trauma-relevant laboratory elicitation and assessment of emotion; 2) the use of experimental psychopathology methods to understand posttraumatic sequelae, including PTSD; and 3) the application of this evidence to the development and refinement of both treatment and prevention programs targeting problematic posttraumatic outcomes. The proposed laboratory-based study represents a key step in the service of these aims by providing a rich context for me to examine mechanisms that can inform the development of tailored, evidence-based interventions. As such, the proposed study utilizes sophisticated laboratory-based procedures to compare rates of decline in the emotional reactivity of disgust and fear in response to repeated exposure to sexual assault-related cues. Specifically, 92 sexually assaulted women will complete a laboratory-based assessment of disgust- and fear-based emotional reactivity in response to repeated exposures to an individualized script-driven imagery procedure. Change in emotional reactivity will be measured following exposure to disgust- and fear- focused sexual assault scripts as well as neutral scripts (control groups). Participants will be randomly assigned to one of four groups (2 experimental, 2 control) where they will receive repeated exposure to disgust-focused and fear-focused sexual assault scripts (experimental groups) or neutral scripts (control groups). Specific study hypotheses are as follows: 1) overall, repeated exposure to sexual assault cues will result in less extinction of disgust-based reactivity compared to fear-based reactivity, 2) repeated exposure to disgust-focused sexual assault cues, compared to exposure to fear-focused cues, will result in greater extinction of disgust-based reactivity, and 3) Repeated exposure to fear-focused sexual assault cues, compared to exposure to disgust- focused cues, will result in greater extinction of fear-based reactivity. Exposure-based procedures are integrated into the most well-established prevention programs and treatments for posttraumatic stress resulting from sexual assault, yet a significant minority of people receiving such interventions do not appear to benefit and people responding well to interventions commonly report residual symptoms . Accordingly, this project aims to understand specific processes and mechanisms that likely affect outcomes of exposure-based interventions to advance efforts to further alleviate the extensive public health burden introduced by PTSD. PUBLIC HEALTH RELEVANCE: While leading scholars in the area of sexual assault have long suggested that emotions other than fear are likely to be impact interventions for posttraumatic problems, the current project incorporates one of the first controlled laboratory investigations of this hypothesis by investigating the effects of exposure to sexual assault- relevant cues on disgust- and fear-based reactivity. Findings from this study will lay the foundation for an investigation of effects of specifically targeting disgust-based reactivity in the treatment of sexual assault- related PTSD. This project is both significant and clinically important in that it seeks to better understand specific processes and mechanisms that likely affect outcomes of exposure-based interventions in an effort to enhance interventions designed to alleviate the extensive public health burden introduced by PTSD.