Neural Mechanisms of a Novel Psychotherapy in Veterans with PTSD and Alcoholism

描述（由申请人提供）： 创伤后应激障碍（PTSD）的发病率在退伍军人中很高。伊拉克和阿富汗退伍军人中的PTSD估计表明，近17%的现役军人和超过24%的预备役军人的PTSD筛查呈阳性。在被诊断患有PTSD的个体中，药物滥用和成瘾的发生率显著升高，酒精使用障碍的合并症最高，估计在寻求PTSD治疗的个体中高达85%。当这些合并症表现出来时，它们会导致比单独的任何一种疾病更差的心理，功能和治疗结果。有证据表明，神经生物学机制，如特定脑结构的失调（例如，杏仁核、杏仁核、前额皮质和纹状体）似乎在并发AD/PTSD的维持和缓解中起关键作用。 目前，还没有翻译成像研究已经检查了大脑激活的模式是否可以预测在这一人群中的治疗反应的差异，并没有试图联系心理治疗干预AD/PTSD个体的神经生物学目标。因此，这项研究的长期目标是使用神经成像工具来提高我们的能力， 提供优化的、有针对性的干预措施，支持改善患有AD/PTSD的退伍军人的预后。该提案的目的是追求这一目标的第一步，是在AD/PTSD治疗前后测量大脑对预期任务和酒精线索反应性任务的反应，以便1）描绘治疗反应的神经概况对经验支持的干预措施，和2）比较基于暴露与基于非暴露的治疗对被认为维持这些病症的神经基质的相对影响。参与者将在一项正在进行的VA资助的随机对照试验中接受两种为期8周的治疗，该试验旨在比较基于焦虑的心理治疗（即，使用延长暴露（科普）同时治疗PTSD和物质使用障碍）与广泛使用的心理治疗寻求安全（SS）相比，后者不包括治疗AD/PTSD的暴露。我们假设，基线模式的大脑反应将涉及到的能力，以改善治疗的背景下，和科普和SS的子组件将差异影响这些神经回路维持AD/PTSD的变化。

DESCRIPTION (provided by applicant): Rates of posttraumatic stress disorder (PTSD) are high among combat Veterans. Estimates of PTSD within Iraq and Afghanistan Veterans suggest that nearly 17% of active duty and over 24% of reserve service members screen positive for PTSD. Among individuals diagnosed with PTSD, the incidence of drug abuse and addiction is markedly elevated, with the highest comorbidity observed for alcohol use disorders, estimated to be as high as 85% in individuals seeking PTSD treatment. When these comorbidities manifest they result in poorer psychological, functional, and treatment outcomes than either disorder alone. Evidence suggests that neurobiological mechanisms, such as dysregulation of specific brain structures (e.g., amygdala, insula, prefrontal cortex, and striatum) appear to play crucial roles in the maintenance and remission of concurrent AD/PTSD. Currently there are no translational imaging studies that have examined whether patterns of brain activation can predict differences in treatment response in this population, and no attempts have been made to link psychotherapeutic interventions to neurobiological targets in AD/PTSD individuals. Therefore, the long- term goal of this line of research is to use neuroimaging tools to advance our ability to provide optimized, targeted interventions that support improved outcomes for Veterans with AD/PTSD. The objective of this proposal, which is a first step in pursuit of this goal, is to measure the brain response to an anticipatory task and an alcohol cue reactivity task before and after treatment for AD/PTSD in order to 1) delineate a neural profile of treatment responsiveness to empirically supported interventions, and 2) to compare the relative effects of an exposure based to a non-exposure based treatment on the neural substrates thought to maintain these disorders. Participants will receive one of two, 8-week-long, treatments within an ongoing, VA-funded, randomized controlled trial designed to compare the effectiveness of an exposure-based psychotherapy (i.e., Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE)) against the widely used psychotherapy, Seeking Safety (SS), that does not include exposure for the treatment of AD/PTSD. We hypothesize that baseline patterns of brain response will relate to the capacity to improve in the context of therapy, and that the sub-components of COPE and SS will differentially affect change in those neural circuits maintaining AD/PTSD.