A Randomized Controlled Trial of Cognitive Control Training for Urgency in a Naturalistic Clinical Setting

项目摘要/摘要 冲动是一种常见且重要的预测破坏性、适应不良行为的指标 精神疾病。研究表明，有一种特定类型的冲动，称为紧迫感，尤其是 这是个问题。这种类型的冲动指的是对强烈情绪的反射性反应。作为情绪失调 是精神疾病的一种公认的跨诊断特征，紧迫感的结构代表了 对情绪的反应和冲动行为的风暴。这种冲动的海拔高度预示着严重的 负面结果包括自我伤害、自杀企图和对治疗的不良反应。尽管有这些可怕的事情 对于严重后果，目前没有针对紧急情况的具体、有针对性的治疗方法。然而，可能的机制 影响这一特征的表达开始被理解。紧迫性与几个认知因素有关 缺陷，包括难以停止有计划的行为(反应抑制)以及难以储存和 在脑海中短时间内处理信息(工作记忆)。最近的研究结果表明， 完成了涉及反应抑制和工作记忆的计算机化练习的人显示 经过两周的治疗后，紧迫感显著降低。然而，目前还不清楚这是否会 在患有严重精神疾病的人中可以观察到改善，或者这种类型的 训练实际上会使大脑中支持反应抑制的潜在区域发生变化， 工作记忆。在这项研究中，我们将招募报告高度紧急的成年患者 精神疾病急性症状的强化部分住院治疗。病人将会是 随机分配接受照常治疗(TAU)或接受TAU加两周 针对反应、抑制和工作记忆的计算机化认知训练计划。所有参与者将 在基线和出院时进行脑活动(EEG)电生理记录 程序，以测试与反应抑制和工作记忆相关的大脑活动的变化。这个 本项目的目标是(1)确认认知训练干预成功地接触到潜在的 大脑机制；(2)测试这种训练是否与抑郁症的更大临床改善有关， 自我伤害的冲动或使用物质的冲动；以及(3)评估患者使用的可行性和可接受性 这种在自然主义背景下的干预。如果成功，这项研究可能会提供证据，证明这种新方法 有效地治疗冲动涉及潜在的生物学机制，在临床上是有效的，并且是 适用于真实世界的临床环境。这些目标与NIMH的第三个战略目标高度一致， 上面写道：“挑战在于测试…潜在的机制，以迅速排除或排除目标作为 这种疾病的发病机制。这需要干预措施与目标接触，并测试其减少 症状。“本研究接受了这一挑战，快速测试以认知为目标的治疗 对精神健康有严重后果的特征的潜在机制。

Project Summary/Abstract Impulsivity is a common and significant predictor of destructive, maladaptive behaviors among people with mental illness. Research shows that one specific type of impulsivity, known as urgency, is particularly problematic. This type of impulsivity refers to reflexive responses to strong emotions. As emotion dysregulation is a well-established transdiagnostic feature of mental illness, the construct of urgency represents a “perfect storm” of both reactivity to emotion and impulsive action. Elevations in this form of impulsivity predict serious negative outcomes including self-injury, suicide attempts, and poor response to treatment. Despite these dire consequences, there are no specific, targeted treatments for urgency. However, the mechanisms that might influence the expression of this trait are beginning to be understood. Urgency is related to several cognitive deficits, including difficulty stopping a planned behavior (response inhibition) as well as difficulty storing and manipulating information in mind for short periods of time (working memory). Recent findings suggest that people who completed computerized exercises involving response inhibition and working memory showed significantly reduced levels of urgency after two weeks of treatment. However, it is unknown if this improvement would be observable among individuals with serious mental illness, or whether this type of training actually produces changes in the putative underlying brain regions that support response inhibition and working memory. In this study, we will recruit adult patients reporting high levels of urgency who are receiving treatment for acute symptoms of mental illness in an intensive Partial Hospitalization Program. Patients will be randomly assigned to receive treatment as usual (TAU) or to receive TAU augmented with a two-week computerized cognitive training program targeting response inhibition and working memory. All participants will undergo electrophysiological recording of brain activity (EEG) at baseline and upon discharge from the program, in order to test changes in brain activity relevant to response inhibition and working memory. The goals of this project are to (1) confirm that the cognitive training intervention successfully engages underlying brain mechanisms; (2) test whether this training is associated with greater clinical improvements in depression, urges to self-injure, or urges to use substances; and (3) assess feasibility and acceptability to patients using this intervention in a naturalistic setting. If successful, this study may provide evidence that this new approach to treating impulsivity effectively engages underlying biological mechanisms, is clinically efficacious, and is applicable to real-world clinical settings. These goals are highly consistent with the NIMH's Third Strategic Aim, which states that “The challenge is to test…potential mechanisms rapidly to rule in or rule out the target as a mechanism of the illness. This requires that the intervention engage the target and test its efficacy for reducing symptoms.” The present study embraces this challenge to rapidly test a treatment targeting cognitive mechanism underlying a trait with serious consequences for mental health.