Cranial electrotherapy stimulation: Piloting a road to PTSD prevention in first responders

项目总结 巴特勒医院科布雷神经调节中心家长奖的目标是支持跨学科 通过创建支持跨学科职业的关键基础设施进行临床-翻译性脑研究 研究人员的总体目标是促进非侵入性神经调节在电路基础上的使用 治疗神经精神障碍，包括创伤后应激障碍。在这样做的时候，眼镜蛇 神经调节中心满足了人们对创新和有效治疗的迫切需求 与精神障碍作斗争。 目前的提议建立在这一总体目标的基础上。具体地说，拟议的行政管理 补充剂旨在测试为期四周的非侵入性颅脑手术的可行性和可接受性 电疗刺激(CES)以及建立CES对体内平衡功能影响的早期信号 在消防员第一反应人员的样本中。消防员患创伤后应激障碍的风险极高 由于其职业性质造成的混乱，既有可怕的个人，也有经济上的，劳动力- 相关后果。因此，迫切需要采取有效的预防性干预措施。 创伤后应激障碍。这在科学上是具有挑战性的，而当前的干预策略旨在 预防创伤后应激障碍的发展要么收效甚微，要么收效甚微(例如， 药物疗法)或当创伤的来源是一个人的职业时实施是不现实的，因此 不可避免的(例如，心理治疗)。消防员经常面临的创伤性事件的反复暴露 使他们面临体内平衡失调的风险，导致了创伤后应激的发病 无序。CES被认为可以重新建立生理平衡，从而减少 (重复)创伤应激。然而，尽管有文献表明CES能有效改善焦虑症状， 失眠和抑郁，CES对体内平衡功能的影响机制仍然相当 这是假设，到目前为止几乎没有直接证据。此外，还应认真整合CES的应用 消防员的工作时间表。尽管CES几乎没有副作用，而且可以安全地进行 在诊所之外，它的使用将被限制在非值班日子，这引发了关于CES的重要问题 消防员的可行性和可接受性。最终，这项工作的长期目标是开发一种 有效、易于部署的积极干预措施预防创伤后应激障碍的发展 在急救队。 为了测试CES动态平衡的可行性、可接受性和早期信号，我们组建了一个协作性的 巴特勒神经调节科布雷医院和罗德岛医院的研究人员之间的合作 医院的科布雷服用阿片类药物和过量药物。神经调节的科布雷和阿片类药物的科布雷 罗德岛州在10分钟的车程内有吸毒和吸毒过量。这种近在咫尺的关系使得 调查人员之间的合作。拟议的免费和跨学科团队将利用 创伤后应激障碍发病机制的专门知识和来自以下领域的方法优势 精神病学(福田博士)、认知神经精神病学(Van‘t Wout-Frank博士)和临床心理学(Weiss博士) 建议使用CES作为一种预防创伤后应激障碍的新方法。福田博士 科布雷神经调节中心支持的一个试点项目的首席研究员和Dr。 科布雷神经调节中心的项目负责人Van‘t Wout-Frank提供了 创伤后应激障碍，支持CES作为非侵入性大脑管理的基础设施 刺激技术，并通过测量大脑活动和(心理)生理来评估其效果， 包括压力荷尔蒙皮质醇和心率变异性。然而，科布雷中心 巴特勒医院的神经调节目前不包括具有综合专业知识的研究人员 创伤后应激障碍和评估非侵入性脑刺激效果的先进技术 技术以自然主义和近乎实时的方式。这项额外的关键专业知识来自Weiss博士， 科布雷的一名项目负责人通过罗德岛医院治疗阿片类药物和过量用药，他将 引导实施生态瞬时评估，实现自然、接近实时的评估 CES的影响。该团队独一无二地准备初步但全面地评估是否和 基于生态监测的CES对预防创伤后应激障碍有何益处 应激反应的主观(即，消极和积极的情绪、疲劳)和客观的生物测定指数(即， 心率变异性、皮质醇、睡眠质量)和神经回路变化(即丘脑功能和默认 模式网络结构和功能连通性)。拟议的项目允许建筑和 加强来自两个不同生物医学研究中心的研究人员之间的新合作 卓越，以扩大和加强科学资源和专门知识，供未来提交的拨款申请解决 在消防员等高危职业中预防创伤后应激障碍的迫切需要 急救人员。

PROJECT SUMMARY The goal of the Butler Hospital COBRE Center for Neuromodulation parent award is to support interdisciplinary clinical-translational brain research by creating the key infrastructure to support the careers of interdisciplinary investigators with as overall objective to advance the use of noninvasive neuromodulation in circuit-based therapies for neuropsychiatric disorders, including posttraumatic stress disorder. In doing so, the COBRE Center for Neuromodulation addresses the pressing need for innovative and effective treatments for people struggling with psychiatric disorders. The current proposal builds upon this overarching objective. Specifically, the proposed administrative supplement aims to test the feasibility and acceptability of a four-week course of noninvasive cranial electrotherapy stimulation (CES) as well as establish an early signal of CES effects on homeostatic functioning in a sample of firefighter first responders. Firefighters are at ultra-high risk for developing posttraumatic stress disorder due to the nature of their occupation which has both dire personal as well as economic, workforce- related consequences. Therefore, there is an urgent need for an effective preventative intervention for posttraumatic stress disorder. This is scientifically challenging, and current intervention strategies that aim to prevent the development of posttraumatic stress disorder have either had little to modest success (e.g., pharmacotherapy) or are unrealistic to implement when the source of trauma is one's occupation and thus unavoidable (e.g., psychotherapy). The repeated exposure to traumatic events regularly faced by firefighters puts them at risk for homeostatic dysregulation, contributing to the pathogenesis of posttraumatic stress disorder. CES is thought to reestablish physiological homeostasis, thus reducing the negative consequences of (repeated) traumatic stress. However, despite literature on CES effectiveness to improve symptoms of anxiety, insomnia, and depression, the mechanism of CES effects on homeostatic functioning remains rather hypothetical with little direct evidence to date. In addition, the application of CES should be carefully integrated with firefighter work schedules. Even though CES carries little to no side effects and can be done safely outside the clinic, its usage would be restricted to off-duty days which raises important questions about CES feasibility and acceptability in firefighters. Ultimately, the long-term goal of this line of work is to develop an effective, easily deployable, proactive intervention to prevent the development of posttraumatic stress disorder in first responders. To test feasibility, acceptability, and early signal of CES homeostasis, we have assembled a collaborative partnership between investigators of the Butler Hospital COBRE for Neuromodulation and the Rhode Island Hospital COBRE on Opioids and Overdose. Both the COBRE for Neuromodulation and the COBRE on Opioids and Overdose are in Rhode Island within a 10-minute driving distance. This proximity permits a close partnership between investigators. The proposed complimentary and interdisciplinary team will leverage expertise on the pathogenesis of posttraumatic stress disorder and methodological strengths from the fields of psychiatry (Dr. Fukuda), cognitive neuropsychiatry (Dr. van ’t Wout-Frank), and clinical psychology (Dr. Weiss) to propose the use of CES as a novel approach to posttraumatic stress disorder prevention. Dr. Fukuda, Principal Investigator on a pilot project supported through the COBRE Center for Neuromodulation, and Dr. van ’t Wout-Frank, Project Leader within the COBRE Center for Neuromodulation, provide the expertise in posttraumatic stress disorder, infrastructure to support the administration of CES as a noninvasive brain stimulation technique, and in assessing its effects via measuring brain activity and (psycho)physiology, including the stress hormone cortisol and heart rate variability. However, the COBRE Center for Neuromodulation at Butler Hospital does not currently include investigators with the combined expertise in posttraumatic stress disorder and advanced skills to assess the effects of noninvasive brain stimulation techniques in a naturalistic and near real-time manner. This additional critical expertise comes from Dr. Weiss, a Project Leader affiliated with the COBRE on Opioids and Overdose through Rhode Island Hospital, who will lead the implementation of ecological momentary assessments to naturalistically and in near real-time assess the effects of CES. This team is uniquely poised to preliminarily, yet comprehensively, assess whether and how CES would be beneficial for prevention of posttraumatic stress disorder based on ecological monitoring of subjective (i.e., negative and positive affect, fatigue) and objective biometric indices of stress responses (i.e., heart rate variability, cortisol, quality of sleep) and neural circuit changes (i.e., thalamic functioning and default mode network structural and functional connectivity). The proposed project allows the building and strengthening of new collaborations between investigators from two distinct Centers of Biomedical Research Excellence to expand and strengthen scientific resources and expertise for future grant submissions to address the critical need to prevent posttraumatic stress disorder in those in high-risk occupations such as firefighter first responders.