Differential Extinction of Specific Types of Posttraumatic Emotional Reactivity

描述(申请人提供)：基于我在学术背景下成为一名临床科学家的总体职业目标，我的工作重点是了解与创伤事件相关的情绪反应范围及其对创伤后应激反应的自然和促进恢复的影响，我正在寻求以下方面的培训：1)使用复杂的方法和分析技术，涉及与创伤相关的实验室启发和情绪评估；2)使用实验精神病理学方法来了解创伤后后遗症，包括创伤后应激障碍；以及3)将这一证据应用于制定和完善针对有问题的创伤后结局的治疗和预防计划。拟议的以实验室为基础的研究为实现这些目标迈出了关键的一步，为我提供了丰富的背景，使我能够审查能够为制定量身定制的循证干预措施提供信息的机制。因此，这项拟议的研究利用复杂的实验室程序来比较在反复暴露于与性侵犯有关的线索时，厌恶和恐惧情绪反应的下降率。具体地说，92名被性侵女性将完成一项基于实验室的基于厌恶和恐惧的情绪反应评估，以回应反复暴露于个性化脚本驱动的成像过程。情绪反应的变化将在暴露于厌恶和恐惧为重点的性侵犯剧本以及中性剧本(控制组)后进行测量。参与者将被随机分配到四组中的一组(两个试验组，两个控制组)，在这些组中，他们将反复接触以厌恶和恐惧为重点的性侵犯剧本(试验组)或中性剧本(对照组)。具体的研究假设如下：1)总体而言，与基于恐惧的反应相比，反复暴露于性侵犯线索将导致基于厌恶的反应性较少的消退；2)与暴露于以恐惧为中心的线索相比，反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更大程度的消退；以及3)与暴露于以厌恶为中心的线索相比，反复暴露于以恐惧为中心的性侵线索将导致基于恐惧的反应性更大的消退。对于性侵犯引起的创伤后应激，基于暴露的程序被整合到最成熟的预防计划和治疗中，但接受此类干预的相当少数人似乎没有受益，对干预反应良好的人通常报告残留症状。因此，该项目旨在了解可能影响基于暴露的干预措施结果的具体过程和机制，以推动进一步减轻创伤后应激障碍带来的广泛公共卫生负担的努力。 公共卫生相关性：虽然性侵领域的知名学者长期以来一直认为，恐惧以外的情绪很可能是创伤后问题的影响干预措施，但当前的项目纳入了对这一假设的首批受控实验室调查之一，调查性侵犯的影响--与厌恶和基于恐惧的反应相关的线索--的影响。这项研究的发现将为研究在治疗性侵犯相关的创伤后应激障碍中特别针对基于厌恶的反应的效果奠定基础。该项目具有重大意义和临床重要性，因为它寻求更好地了解可能影响基于暴露的干预措施结果的具体过程和机制，以努力加强旨在减轻创伤后应激障碍带来的广泛公共卫生负担的干预措施。

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.