The Role of Neural Systems for Emotion Regulation in Coping with Alcohol Craving

描述(由申请人提供)：在这份K23职业发展奖的申请中，首席研究员纳斯尔·纳克维，医学博士，提出了一项全面的计划，以成为一名能够整合认知神经科学和临床方法的独立翻译研究人员，以阐明酒精依赖的心理社会治疗改变行为的神经机制。心理社会治疗被普遍使用，尽管它们充其量只能保持适度的效果。通过确定心理社会治疗改变饮酒行为的神经机制，可能会提高它们的疗效。该项目特别关注认知行为应对技能疗法(CBCST)，这是一种以证据为基础的心理社会治疗，通过教授管理与酒精有关的思想和情绪的“应对技能”来促进戒酒。这项拟议的研究结合了(1)CBCST在已完成住院康复并以维持戒酒为目标的酒精依赖患者中的临床试验和(2)功能磁共振(FMRI)实验，该实验探索与CBCST教授的一种特定应对技能的使用有关的神经活动：通过考虑饮酒的负面后果来减少线索诱导的渴望。功能磁共振研究将在CBCST治疗前和治疗后立即进行，目的是确定(1)在接受CBCST之前与应对技能利用有关的神经活动模式，特别是已知在情绪调节中发挥作用的神经系统~(2)这种神经活动模式是否预测CBCST期间戒酒与复发的关系，以及(3)CBCST如何改变这种神经活动模式。纳克维博士在被公认为心理社会治疗机制(Jon Morgenstein，PhD)和情绪调节认知神经科学(Kevin Ochsner，PhD)专家的导师的指导下从事这方面的研究，他将在以下领域从事全面的培训计划：(1)功能磁共振方法~(2)临床试验方法~(3)翻译神经成像~(4)有关社会认知神经科学、情绪调节和心理社会治疗机制的相关文献~和(5)赠款的撰写和管理技能。这个培训项目将建立在纳克维博士作为一名成瘾精神病学家的背景之上，他在治疗酒精依赖方面拥有丰富的经验，但在临床研究方面的经验相对较少。此外，尽管纳克维博士是一名受过博士培训的认知神经学家，他已经为我们理解成瘾的病理生理学做出了重大贡献，但他之前没有接受过培训，也没有使用功能磁共振成像方法的经验。因此，K23奖项将支持以患者为中心的创新和临床相关研究计划，同时帮助纳克维博士获得关键技能，确保他发展成为一名独立的翻译研究人员。

DESCRIPTION (provided by applicant): In this application for a K23 Career Development Award, the Principal Investigator, Nasir Naqvi, MD, PhD, proposes a comprehensive plan for becoming an independent translational researcher who is capable of integrating cognitive neuroscience and clinical methods in order to elucidate the neural mechanisms by which psychosocial treatments for alcohol dependence change behavior. Psychosocial treatments are commonly utilized, though they remain at best only moderately effective. By identifying the neural mechanisms through which psychosocial treatments change drinking behavior, it may be possible to improve their efficacy. The project focuses specifically on Cognitive Behavioral Coping Skills Therapy (CBCST), an evidence-based psychosocial treatment that promotes abstinence by teaching "coping skills" for managing alcohol-related thoughts and emotions. The proposed research combines (1) a clinical trial of CBCST in alcohol dependent patients who have completed inpatient rehabilitation and have a goal of maintaining abstinence with (2) functional MRI (fMRI) experiments that probe neural activity related to the utilization of a specifc coping skill that is taught in CBCST: reducing cue-induced craving by thinking about the negative consequences of drinking. The fMRI studies will be performed both before and immediately after treatment with CBCST, with the goal of determining (1) the pattern of neural activity that is related to coping skills utilization prior to undergoing CBCST, with particular fous on neural systems known to play a role in emotion regulation~ (2) whether this pattern of neural activity predicts abstinence vs. relapse during CBCST~ and (3) how CBCST changes this pattern of neural activity. While pursuing this line of research under the guidance of mentors who are recognized experts in psychosocial treatment mechanisms (Jon Morgenstern, PhD) and the cognitive neuroscience of emotion regulation (Kevin Ochsner, PhD), Dr. Naqvi will engage in a comprehensive training program in the following areas: (1) fMRI methods~ (2) clinical trials methods~ (3) translational neuroimaging~ (4) the relevant literature on social cognitive neuroscience, emotion regulation and psychosocial treatment mechanisms~ and (5) grant writing and management skills. This training program will build upon Dr. Naqvi's background as an addiction psychiatrist who has significant experience treating alcohol dependence, but who has relatively little experience in clinical research. Furthermore, while Dr. Naqvi is a PhD-trained cognitive neuroscientist who has already made substantial contributions to our understanding of the pathophysiology of addiction, he has no prior training or experience using fMRI methods. Thus, the K23 award will support an innovative and clinically relevant program of patient-oriented research, while helping Dr. Naqvi acquire critical skills that will ensure his development into an independent translational researcher.