Project IMPACT: In-the-Moment Protection from Automatic Capture by Triggers

描述（由申请人提供）：有有效的行为干预措施来治疗酒精使用障碍，但随着时间的推移，当客户发现自己由于负面情绪和食欲线索而无法抗拒饮酒时，治疗收益往往会丢失。内部和环境的“触发因素”引发复发的力量，即使在有意识的禁欲目标和长期禁欲的客户中，也是令人信服的和有据可查的。因此，支持客户在真实的时间内承受饮酒触发和渴望的能力可能会产生巨大的公共卫生影响。本申请提出了翻译研究，重点是先验定义和可塑性压力反射（BAR）机制。BAR是一种动态机制，通过调节心脏和大脑之间的双向通信，帮助调节自动内脏对酒精和其他药物使用触发的反应。BAR机制的一个关键特征是，它可以使用一种简单的行为呼吸技术（称为共振呼吸）有意识地操纵。这种操纵可以发生在“当下”，也可以发生在治疗背景之外，因为预期或遇到了触发因素。本申请提出了一种基于BAR的干预（像往常一样添加到行为治疗中）与实验室评估（干预前后设计）相结合的随机临床试验，以及用于验证BAR作为生物行为变化机制的操作的计算建模。样本包括妇女与幼儿从经验支持，密集的门诊行为治疗计划（IOP）。干预包括在IOP治疗第4-12周期间每天使用iPhone应用程序（app）。那些随机接受主动干预的人将接受培训，使用现有的共振呼吸应用程序来激活BAR机制，因为他们预期或面对可能引发复发的情绪或线索。安慰剂组的参与者将使用不影响BAR的应用程序。目标1将解决激活BAR机制是否加速和稳定积极的行为变化，特别是治疗期间和治疗后酒精和药物使用，焦虑，渴望，抑郁的变化。目标2将比较自然与操纵的变化，BAR功能干预前后使用生理，并为一个子集的妇女，功能磁共振成像数据，以关联生物和行为的变化。目标3将描述BAR机制如何以及为谁支持行为改变，使用计算建模来捕获人体内多个相互作用的生物系统的变化。这项研究的新奇来自于专注于一个明确的自动生理机制，捕捉充满触发和情感变化的“真实的生活”动态空间的变化，使用变量和以人为中心的定量策略表征生物行为水平的BAR机制，并专注于一个未充分研究的人群，其积极的行为变化可能具有重要的直接和长期的健康影响。如果成功，拟议的研究将为新一代基于机制的干预方法和个性化预后模型奠定基础。

DESCRIPTION (provided by applicant): There are effective behavioral interventions to treat alcohol use disorders, but over time, treatment gains are often lost when clients find themselves unable to resist drinking because of negative emotions and appetitive cues. The power of internal and environmental "triggers" to elicit relapse, even among clients with conscious abstinence goals and extended abstinence, is compelling and well-documented. Thus, bolstering clients' ability to withstand drinking triggers and craving in real time could have tremendous public health impact. This application proposes translational research that focuses on the a priori defined and malleable baroreflex (BAR) mechanism. The BAR is a dynamic mechanism that helps to regulate automatic-visceral reactivity to triggers of alcohol and other drug use by regulating bidirectional communication between the heart and brain. A key feature of the BAR mechanism is that it can be consciously manipulated using a simple behavioral breathing technique called resonance breathing. This manipulation can occur "in the moment" and outside of the treatment context as triggers are anticipated or encountered. This application proposes a randomized clinical trial of a BAR-based intervention (added to behavioral treatment as usual) in conjunction with laboratory assessments (pre-post intervention design), and computational modeling to validate the operation of the BAR as a biobehavioral change mechanism. The sample comprises women with young children from an empirically supported, intensive outpatient behavioral treatment program (IOP). The intervention involves daily use of iPhone applications (apps) during IOP treatment weeks 4-12. Those randomized to the active intervention will be trained to use an existing resonance breathing app to activate the BAR mechanism as they anticipate or confront emotions or cues that can trigger relapse. Participants in the placebo group will use an app that does not affect the BAR. Aim 1 will address whether activating the BAR mechanism accelerates and stabilizes positive behavior change, specifically change in alcohol and drug use, anxiety, craving, depression during and after treatment. Aim 2 will compare natural versus manipulated changes in BAR functioning pre- to post- intervention using physiological, and, for a subset of women, fMRI data to correlate biological and behavioral change. Aim 3 will characterize how and for whom the BAR mechanism supports behavior change using computational modeling to capture change across multiple interacting biological systems within a person. The novelty of this study comes from focusing on a well-specified automatic-physiological mechanism, capturing change in the dynamic space of "real life" replete with triggers and affective changes, characterizing the BAR mechanism across biobehavioral levels using variable-and person-centered quantitative strategies, and focusing on an understudied population whose positive behavior change can have important immediate and long-term health implications. If successful, the proposed research will set the stage for a new generation of mechanism-based intervention approaches and personalized prognostic models.