在酒精使用障碍的认知行为疗法期间减少饮酒与前脑岛-终纹床核静息状态功能连接减少有关。
Drinking reduction during cognitive behavioral therapy for alcohol use disorder is associated with a reduction in anterior insula-bed nucleus of the stria terminalis resting-state functional connectivity.
机构信息
Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA.
Division of Experimental Therapeutics, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York, USA.
出版信息
Alcohol Clin Exp Res. 2021 Aug;45(8):1596-1606. doi: 10.1111/acer.14661. Epub 2021 Aug 2.
BACKGROUND
Connectivity between the anterior insula (AI) and the bed nucleus of the stria terminalis (BNST) may play a role in negative emotions that drive compulsive drinking in patients with alcohol use disorder (AUD). We hypothesized that reductions in drinking during cognitive behavioral therapy (CBT), an effective treatment that teaches regulation (coping) skills for managing negative emotions during abstinence, would be associated with reductions in resting-state functional connectivity (RSFC) between the AI and the BNST.
METHODS
We included 18 patients with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of AUD who were (1) seeking treatment and (2) drinking heavily at baseline. We measured RSFC as Pearson's correlation between the BNST and multiple regions of interest in the insula at baseline and after completion of 12 weeks of a single-arm clinical trial of outpatient CBT. We also assessed the number of heavy drinking days over the previous 28 days (NHDD) at both time points. We used 1-sample t-tests to evaluate AI-BNST RSFC at baseline, paired t-tests to evaluate changes in AI-BNST RSFC from pre-CBT to post-CBT, and linear regression to evaluate the relationship between changes in AI-BNST RSFC and NHDD.
RESULTS
We found a significant positive RSFC between the AI and the BNST at baseline (p = 0.0015). While there were no significant changes in AI-BNST RSFC from pre- to post-CBT at the group level (p = 0.42), we found that individual differences in reductions in AI-BNST RSFC from pre- to post-CBT were directly related to reductions in NHDD from pre- to post-CBT (r = 0.73, p = 0.0008).
CONCLUSIONS
These findings provide preliminary evidence that reduced AI-BNST RSFC may be a mechanism of drinking reduction in AUD and that AI-BNST RSFC may be a target for CBT and possibly other treatments.
背景
前脑岛（AI）与终纹床核（BNST）之间的连接可能在驱使患有酒精使用障碍（AUD）的患者产生强迫性饮酒的负面情绪中发挥作用。我们假设，认知行为疗法（CBT）治疗期间饮酒量的减少（一种有效的治疗方法，教授在禁欲期间管理负面情绪的调节（应对）技能）与 AI 和 BNST 之间静息状态功能连接（RSFC）的减少相关。
方法
我们纳入了 18 名患有精神障碍诊断与统计手册，第五版（DSM-5）酒精使用障碍诊断的患者，他们（1）正在寻求治疗，（2）基线时大量饮酒。我们在基线时和接受为期 12 周的门诊 CBT 单臂临床试验后，测量 BNST 与脑岛多个感兴趣区之间的 RSFC，作为 Pearson 相关性。我们还评估了两个时间点过去 28 天内的重度饮酒天数（NHDD）。我们使用 1 样本 t 检验评估基线时的 AI-BNST RSFC，配对 t 检验评估 CBT 前至 CBT 后的 AI-BNST RSFC 变化，线性回归评估 AI-BNST RSFC 变化与 NHDD 的关系。
结果
我们发现在基线时 AI 与 BNST 之间存在显著的正 RSFC（p=0.0015）。虽然在组水平上，从 CBT 前到 CBT 后 AI-BNST RSFC 没有显著变化（p=0.42），但我们发现从 CBT 前到 CBT 后 AI-BNST RSFC 减少的个体差异与从 CBT 前到 CBT 后 NHDD 的减少直接相关（r=0.73，p=0.0008）。
结论
这些发现提供了初步证据，表明 AI-BNST RSFC 的减少可能是 AUD 减少饮酒的一种机制，并且 AI-BNST RSFC 可能是 CBT 及可能其他治疗的靶点。
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