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 &纽曼，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，有一个强有力的先例来区分与情绪反应或情绪稳定形式的精神病相关的风险因素。虽然这两种类型都与严重的物质滥用有关，但这两种亚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，我们利用最近的进展，区分和表征与这些亚型相关的心理生物学缺陷，开发新的认知补救方案，匹配各自的技能缺陷，并评估这些方案是否会导致更大的变化比那些不解决假定的缺陷。具体来说，128名被诊断为情绪反应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，旨在发展与情绪反应或情绪稳定型精神病罪犯的自我调节缺陷有关的核心认知技能。一个干预（ACC）的目标与情绪反应型罪犯的情感认知控制缺陷，而另一个干预（ATC）的目标与情绪稳定型罪犯的上下文赤字的关注。为了评估ACC和ATC在这一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措施，这些措施在过去的研究中被发现可以区分情绪反应和情绪稳定的精神病罪犯。我们预测，设计用于补救一个实验组的认知缺陷的治疗将导致比设计用于补救另一个实验组的认知缺陷的治疗显著更大的变化。研究结果将（a）提供重要的基线信息，即在缺乏旨在增强此类训练对日常功能的推广的支持性认知行为材料的情况下，基于计算机的简短干预可能预期的变化幅度;（B）阐明在这两种类似反社会但病因不同的患者中证明差异治疗反应的可能性，亚型 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，有必要改进将这些进展转化为有意义的治疗干预的技术。为此，我们（a）将与情绪反应型和情绪稳定型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措施，这些干预措施旨在训练克服缺陷和减少酒精/药物滥用的技能，（B）检查这些缺陷集中的干预措施在多大程度上改变了与疾病相关的大脑相关反应，以及（c）检验缺陷匹配治疗产生显著更大的治疗后变化的假设。

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.