DeVito Elise E, Dong Guangheng, Kober Hedy, Xu Jiansong, Carroll Kathleen M, Potenza Marc N
Department of Psychiatry, Yale University School of Medicine.
Department of Psychiatry, Neurobiology, and Child Study Center, Yale University School of Medicine.
Psychol Addict Behav. 2017 Aug;31(5):534-547. doi: 10.1037/adb0000298. Epub 2017 Jul 17.
A growing literature exists on neural correlates of treatment outcome. However, different types-or components of-treatment have distinct theorized mechanisms of action. And it is not yet known how changes in neural activity across treatment relate to engagement in different treatment components. Participants with cocaine use disorders in a randomized clinical trial received cognitive-behavioral therapy (CBT) plus, in a 2 × 2 design, contingency management (CM) or no CM, and disulfiram or placebo. Participants performed a functional MRI Stroop task, a measure of cognitive control, at the beginning of and after the 12-week treatment. Analyses assessed changes in Stroop-related neural activity within the sample overall and assessed how changes in Stroop-related activity correlated with measures of treatment process specific to each form of treatment (i.e., participation in CBT sessions, receipt of CM prizes, administration of disulfiram pills). Within the sample overall, compared with beginning of treatment, posttreatment Stroop-related neural activity was diminished in the hippocampus, thalamus, cingulate, precentral, post- and precentral gyrus, and precuneus and culmen regions (pFWE < .05). In separate whole-brain correlation analyses, greater reductions in Stroop-related activity were associated with more treatment engagement-"CBT sessions" with the precentral gyrus, inferior parietal lobule, and middle and medial frontal gyrus; "CM prizes" with the postcentral frontal gyrus. Disulfiram "medication days" were not associated with changes in Stroop-related activity. Findings suggest that key process indicators of CBT and CM may be associated with functional changes in cognitive-control-related neurocircuitry. (PsycINFO Database Record
关于治疗结果的神经关联的文献越来越多。然而，不同类型或组成部分的治疗具有不同的理论作用机制。目前尚不清楚治疗过程中神经活动的变化如何与参与不同治疗组成部分相关。在一项随机临床试验中，患有可卡因使用障碍的参与者接受了认知行为疗法（CBT），并采用2×2设计，接受应急管理（CM）或不接受CM，以及服用双硫仑或安慰剂。参与者在12周治疗开始时和结束后进行了功能性磁共振成像斯特鲁普任务，这是一种认知控制的测量方法。分析评估了样本总体中与斯特鲁普相关的神经活动变化，并评估了与每种治疗形式特定的治疗过程测量指标（即参与CBT疗程、获得CM奖励、服用双硫仑药丸）相关的斯特鲁普相关活动变化。在整个样本中，与治疗开始时相比，治疗后海马体、丘脑、扣带回、中央前回、中央后回和中央前回、楔前叶和山顶区域中与斯特鲁普相关的神经活动减少（pFWE<0.05）。在单独的全脑相关性分析中，与斯特鲁普相关活动的更大减少与更多的治疗参与相关——“CBT疗程”与中央前回、顶下小叶以及额中回和额内侧回相关；“CM奖励”与中央后额回相关。双硫仑的“用药天数”与斯特鲁普相关活动的变化无关。研究结果表明，CBT和CM的关键过程指标可能与认知控制相关神经回路的功能变化有关。（PsycINFO数据库记录）
