Matching Cognitive Remediation to Cognitive Deficits in Substance-Abusing Inmates

描述（由申请人提供）：精神病患者酗酒和滥用药物以及各种形式的反社会行为的风险很高（Smith & Newman, 1990）。因此，解决与精神病相关的风险因素可能被证明是成功治疗药物滥用的关键，特别是在监禁样本中。在这方面，有一个强有力的先例来区分与情绪反应性或情绪稳定型精神病相关的风险因素。虽然这两种类型都与严重的药物滥用有关，但这两种亚型的自我控制问题与明显的认知情感缺陷有关。在本研究中，我们利用在区分和描述与这些亚型相关的心理生物学缺陷方面的最新进展，开发出与各自技能缺陷相匹配的新型认知修复方案，并评估这些方案是否比那些不解决假定缺陷的方案产生更大的变化。具体来说，128名被诊断为情绪反应型或情绪稳定型精神病的监禁罪犯将接受两种基于计算机的干预之一，旨在培养核心认知技能，这些技能与情绪反应型或情绪稳定型精神病罪犯的自我调节缺陷有关。一种干预（ACC）针对情绪反应型犯罪者的情感认知控制缺陷，另一种干预（ATC）针对情绪稳定型犯罪者的情境注意缺陷。为了在初步调查中评估ACC和ATC的影响和特异性，我们将使用治疗前和治疗后的行为和大脑相关测量，这些测量在过去的研究中被发现用于区分情绪反应性和情绪稳定型精神病罪犯。我们预测，旨在纠正一个实验组的认知缺陷的治疗将比旨在纠正另一个实验组的认知缺陷的治疗产生更大的变化。该研究的结果将(a)提供重要的基线信息，说明在缺乏认知行为材料支持的情况下，基于计算机的简短干预可能带来的变化幅度；(b)阐明在这两种相似的反社会但病因不同的亚型中证明不同治疗反应的合理性。

DESCRIPTION (provided by applicant): People with psychopathy are at high risk for alcohol and drug abuse as well as diverse forms of antisocial behavior (Smith & Newman, 1990). Thus, addressing the risk factors associated with psychopathy may prove to be crucial for the successful treatment of substance abuse, especially in incarcerated samples. In this regard, there is a strong precedent for differentiating the risk factors associated with emotionally reactive or emotionally stable forms of psychopathy. Although both types are associated with significant substance abuse, the self-control problems of these two subtypes are associated with distinct cognitive-affective deficits. In the proposed research, we use recent progress in distinguishing and characterizing the psychobiological deficits associated with these subtypes to develop novel cognitive remediation protocols that match their respective skill deficits and evaluate whether these protocols result in greater change than those that do not address the putative deficits. Specifically, 128 incarcerated offenders diagnosed with emotionally reactive or emotionally stable forms of psychopathy will receive one of two computer-based interventions designed to develop core cognitive skills that have been linked to self-regulation deficits in either emotionally reactive or emotionally stable psychopathic offenders. One intervention (ACC) targets the affective cognitive control deficits associated with emotionally reactive offenders whereas the other intervention (ATC) targets the attention to context deficits associated with emotionally stable offenders. To evaluate the impact and specificity of the ACC and ATC in this initial investigation, we will use pre- and post-treatment behavioral and brain-related measures that have been found to distinguish emotionally reactive and emotionally stable psychopathic offenders in past research. We predict that a treatment designed to remediate the cognitive deficits of one experimental group will result in significantly greater change than a treatment designed to remediate the cognitive deficits of the other experimental group. The results of the study will (a) provide important baseline information concerning the magnitude of change that may be expected from a brief computer-based intervention in the absence of supporting cognitive-behavioral materials designed to enhance the generalization of such training to daily functioning and (b) shed light on the plausibility of demonstrating differential treatment responses in these two similarly antisocial, but etiologically distinct, subtypes. PUBLIC HEALTH RELEVANCE: To realize the potential of research advances in experimental psychopathology, it is necessary to improve the technology for translating these advances into meaningful therapeutic interventions. Toward this end, we (a) translate research on the distinct psychobiological mechanisms associated with emotionally-reactive and emotionally-stable criminal offenders into distinct computer-assisted interventions that train skills designed to overcome their deficits and reduce alcohol / drug abuse, (b) examine the extent to which these deficit-focused interventions modify brain-related responses associated with the disorders, and (c) test the hypothesis that deficit-matched treatments produce significantly greater post-treatment change.