Identification of neural indices of distress tolerance using fMRI

描述(由申请人提供)：证据表明，痛苦不耐受，或一个人在经历情感痛苦时无法坚持目标导向的活动，提供了避免情感痛苦的行为指标，并表明在戒酒尝试的早期阶段保持戒酒和接受治疗的能力。尽管痛苦不耐受行为测量在确定不良药物使用结果的风险个人方面是有用的，但这项工作尚未被用于能够确定与痛苦不耐受相关的神经过程的评估范式。尽管以前的研究已经确定了与复发过程有关的关键神经结构，包括前额叶和边缘区域，但到目前为止，还没有一项研究将这些区域纳入评估范式，以捕捉一个人在不参与回避行为的情况下忍受痛苦的能力。因此，这项研究的具体目标将允许情感和认知神经科学领域的科学家与临床和行为心理学之间的桥梁，利用功能磁共振成像中经过充分验证的痛苦不耐受范例来确定导致痛苦不耐受的关键神经生物学指标。痛苦不耐受范式为这一研究提供了一种经验性验证和创新的方法，因为它(1)在目标定向活动的背景下引发实时痛苦，而不是回忆以前令人痛苦的事件或观看痛苦的图片，(2)反复证明与许多“现实世界”药物滥用结果的关系，或许最重要的是，(3)允许研究一个人在实验过程中对痛苦的行为反应(即退出任务)。具体地说，本申请的主要目的是在30名健康的非吸毒者和30名接受住宅药物滥用治疗的可卡因依赖者的样本中确定与避免情绪性痛苦(即痛苦耐受)有关的神经过程，以及这些神经过程在解释痛苦不耐受和可卡因依赖之间的关系方面的影响。 公共卫生相关性：痛苦不耐受(即避免情感痛苦)与药物依赖、药物复吸以及DSM-IV临界性人格障碍、反社会人格障碍和神经性暴食症的发生率增加有关。因此，识别导致痛苦耐受的神经机制将有助于制定适当的预防和干预计划，因此具有相当大的公共卫生意义。目前应用的主要目的是确定30名健康的非吸毒者和30名接受住宅药物滥用治疗的可卡因依赖者的样本中与痛苦耐受有关的神经过程，以及这些神经过程对解释痛苦不耐受和可卡因依赖之间的关系的影响。

DESCRIPTION (provided by applicant): Evidence indicates that distress intolerance, or one's inability to persist in goal directed activity while experiencing affective distress, provides a behavioral proxy of avoidance of affective distress, and is indicative of the ability to remain abstinent and in treatment during the early stages of an abstinence attempt. Despite the utility of the behavioral measures of distress intolerance in identifying individuals at risk for poor substance use outcomes, this line of work has yet to be utilized in an assessment paradigm capable of identifying the neural processes associated with distress intolerance. Although previous studies have identified key neural structures implicated in the relapse process including prefrontal and limbic regions, none to date have integrated these areas in an assessment paradigm that captures one's ability to tolerate distress without engaging in avoidance behavior. The specific aims of this study will thus allow for the bridging of scientists within affective and cognitive neuroscience with clinical and behavioral psychology in the utilization of a well validated distress intolerance paradigm in fMRI to identify key neurobiological indices responsible for distress intolerance. The distress intolerance paradigm provides an empirically validated and innovative approach to this line of research because it (1) elicits real-time distress in the context of goal directed activity as opposed to recalling a previously distressing event or viewing distressing pictures, (2) has repeatedly demonstrated a relationship with a number of "real-world" substance abuse outcomes, and perhaps most importantly, (3) allows for the study of one's behavioral response to distress (i.e. quitting the task) during the experimental procedure. Specifically, the primary aims of the current application are to identify the neural processes associated with the avoidance of affective distress (i.e., distress intolerance) in a sample of 30 healthy non-drug using and 30 cocaine dependent adults entering residential substance abuse treatment (Total n = 60), and the influence of these neural processes in explaining the relationship between distress intolerance and cocaine dependence. PUBLIC HEALTH RELEVANCE: Distress intolerance (i.e., the avoidance of affective distress) is associated with increased rates of substance dependence, relapse to substance use, as well as incidence of DSM-IV borderline personality disorder, antisocial personality disorder, and bulimia nervosa. Thus, identifying the neural mechanisms underlying distress intolerance will aide in the development of appropriate prevention and intervention programs and therefore holds considerable public health significance. The primary aims of the current application are to identify the neural processes associated with distress intolerance in a sample of 30 healthy non-drug using and 30 cocaine dependent adults entering residential substance abuse treatment (total n = 60), as well as the influence of these neural processes on explaining the relationship between distress intolerance and cocaine dependence.